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 foster-based rescue. We do not have a central office. 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. Applicants 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 pay only 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

Does your family receive any form of public assistance? Please check all that apply. *
 

The Dog(s)

Who does the dog belong to? *
 
Has the dog been scanned for a microchip? *

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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