Senior Pet Companion Program Veterinary Assistance Application

    If you are seeking assistance for Spay or Neuter please go back to our website and fill out the Spay it Forward application. If not, please continue.

    Thank you for contacting Wags to Riches regarding assistance with medical care for your pet. We’re happy to help! Please note that this program is for those who qualify as a senior citizen, (62 years of age and older) and meet low-income levels. Approvals are based on the below qualifications and funds available. You must be a resident of Yakima County.

    Please fill out the below application to see if you qualify. If approved, a volunteer will contact you at the email or phone number you provided. If you wish to be contacted by phone, please make sure you have a working voicemail set up on your phone. Also be willing to answer an unidentified number as our volunteers sometimes choose to keep their numbers private. Please allow one (1) week for our volunteers to respond. Make sure to check your spam box for an email from us. Applications that are not approved may not receive a response. For any questions, please contact our main line at (509) 453-4155.

    Full Name:

    Address:

    City: State: Zip:

    Primary Phone: Secondary Phone:

    Email Address:

    Your Birthdate:

    What is your average monthly income?

    PET INFORMATION

    Pet Type?

    Pet Name: Pet Age (approx.): Pet weight (approx.):

    Pet Sex?

    Pet breed:

    Pet color:

    Is your pet up to date on the Rabies shot?

    Is your pet micro-chipped?

    Medical Information:

    Please describe the nature of your pet’s medical need.

    (Note: if your pet’s medical need is urgent and you are already an approved client, please call Wags’ main number (509)453-4155.)

    Veterinarian Information:

    Please enter their contact info below.
    If you do not currently have a regular veterinarian it is your responsibility to find a Veterinarian who will accept you as a client.

    Please be aware there is a shortage of Veterinarians in our area.

    Veterinarian’s Name:

    Clinic Name:

    Address:

    City: State: Zip:

    Primary Phone:

    What is the maximum amount that you are able to contribute toward your pet’s care?

    What is the estimated cost of recommended treatment?

    Have you requested assistance from another rescue?

    If you answered yes to the above question provide other rescues name:

    Have you requested assistance from Wags in the past?

    If yes please provide year(s) and pet name(s):

    Is there another pet in the household that needs medical attention? If so enter information below:

    Pet 2

    Pet Type?

    Pet Name: Pet Age (approx.): Pet weight (approx.):

    Pet Sex?

    Pet breed:

    Pet color:

    Is your pet up to date on the Rabies shot?

    Is your pet micro-chipped?

    SIGNATURE

    By typing your name in this box you are signifying that you own this pet(s) and that the information provided in this application is accurate. Wags will not be responsible for the cost of any missed appointments. It will be the pet owner’s responsibility to pay that cost.

    Please remember we are all volunteer so a response may take a few days.

    Signature (by entering name that signifies your signature) Date