Bama Bully Rescue Medical Assistance Application

BBR's medical fund provides limited assistance to owned/rescued pit bulls within certain guidelines. Please apply for "Care Credit" through your vet office, if offered, before completing this application.

Instructions: BBR is an internet-based organization. You must have access to a computer and e-mail, or we won't be able to help. You must be able to check your e-mail on a regular basis for this service to be efficient. Allow a few days for your request to be processed. A member of the fund committee will contact you as soon as possible. All questions must be answered. If you do not know the answer, or it does not apply, please enter N/A. Applicant will be required to re-submit incomplete applications. There is a "comments" section at the bottom of the form for any additional information you may want to add. All correspondence should be sent to fixabull@bamabully.org

 

Please note :

  • This application is ONLY for medical assistance other than spay or neuter, if you are looking for additional spay/neuter assistance please use the appropriate form.
  • We cannot reimburse for procedures that have already been completed.
  • All funding must be pre-approved and we only pay the vet clinic directly.
  • If you work for a clinic and have a client that is unable to fill out the application due to disability or lack of internet access, please contact us at fixabull@bamabully.org
  • If you haven't heard from us within 7 days of submitting your application, check your spam folder for our volunteer's response. The name you submit on the application will appear in the subject line.

Personal Information

The Dog(s)

Are you the dog(s) owner? *
Sex? *
Is the dog(s) up to date on it's Rabies vaccinations? *
Is your dog spayed or neutered? *
If no, will you agree to have it done if we provide funding? *

Veterinarian and Funding

Additional Information

I give consent for BBR to use this dog's name, location and photo for fundraising and promotional purposes. *

BBR asks that in exchange for this assistance that you "Pay it Forward" when you're able to in the future. Examples of this request are: Volunteering with us or your local animal shelter, donating to BBR's Medical Assistance Fund or another local spay and neuter initiative, such as Friends of Cats and Dogs (FCDF.org)

FOR BBR USE ONLY:

 

Received by:                                                                                                        

Date:                                                                  

 

Approved:                        Denied:                         Amount:$                

 

Funding Source/Grant Allocation:

                                                                                                                                           

 

Clinic used:                                                                                                                           

 

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