Assistance with End of Life Care

Todd’s Medical Fund does cover end of life care: humane euthanasia and communal cremation. For at-home euthanasia services, please schedule with our partner Heal House Call Veterinary.

We aim for review within 72 hours of receipt of a completed application. In urgent cases we will try to expedite review. We will do our best to notify you within 72 hours of receiving the required application and documentation.

Todd's Medical Fund: End of Life Care Application

Please tell us why you are seeking end-of-life care for your pet.*
What amount can you pay toward end-of-life care for your pet?*
If you've seen a vet, what is the pronosis of your pet?
Name*
First Last
Are you at least 18 years of age, and legally responsible for this animal*
- Yes, I am.
- No, I am not.
I am at least 18 years of age, and legally responsible for this animal
Email*
Phone*
Physical Address*
Street Address Address Line 2 City State ZIP Code
Household size (Including yourself, spouse, children, etc)*
Gross Annual Household Income (please include all income/salaries in mutli-wage home)*
Please enter a number from 1 to 1000000000.
Gross income = total income BEFORE taxes. You may be required to provide W-2 forms to verify income.
Place of employment*
Please list how many other pets are in your care by species.*
Pet's Name*
Species*
Breed*

(If you do not know, please list unknown)
Gender*
Age*
Is your pet spayed/neutered?*
- Yes
- No
How/Where did you acquire your pet*
If you marked Rescue Group/Shelter, please name
Name of regular Veterinarian or Hospital*
Veterinarian Phone*
Does your pet have a chronic medical condition*
- Yes
- No
(i.e. allergies, vaccine reactions, immune mediated disease, on long term medication?)
If yes, please describe
(If applicable) Name and number of Veterinarian who provided prognosis.
Please provide an explanation for why you can't afford end-of-life care for your pet.*
Signature*

(By typing your name here, you hereby certify the above information is true and correct)

Assistance with End of Life Care

Todd's Medical Fund: End of Life Care Application

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