Your Name *
To maintain your privacy, your name won't be used for fundraising purposes.
Household Members *
Besides you, we'd like to know the other members living in your household (check all that apply).
Pet's Name *
We need a story about one dog or one cat at a time. If you have more than one pet, and you want to tell us a story about more than one pet, please finish your story about this pet, click on the Submit button below, and then start a new story.
Pet Type *
We can only accept stories about dogs and cats.
Pet's Description *
A description of this pet includes what they look like (coat color, length of the coat, unusual features or markings, etc.), breed (if known), male or female, spayed/neutered, age or date of birth (if known), etc.
Pet's Origin *
Where did you get this pet? Please choose the best one from the options below. If none of these apply, select "Other."
Role of This Pet *
What main role(s) does this pet play in your life? Check all that apply.
Pet Interactions *
What are some of the favorite things you like to do with this pet (go for walks, watch TV, play, teach them tricks, go shopping, etc.).
Your Pet's Environment *
Think of those places inside and outside your home where this pet spends any time. Check all that apply.
Special Story *
Tell the story of a special time you had with this pet. For example, how they helped you physically or emotionally and what was going on in your life at that time that made it special.
Pet's Meaning for You *
What does this pet mean to you? Describe how this pet makes you feel when you interact with them.
Current Veterinarian *
Please name the veterinarian or veterinary clinic you like to use for this pet. If you don't know, enter:"Don't know." If you don't have one, enter "I don't have one."
Taking to the Veterinarian *
Think of the time(s) this pet went to any veterinarian in the past and who took them. Check all the options that apply.
Veterinary Care in the Past *
Think of the time(s) this pet went to any veterinarian in the past and the reason why. Check all the options that apply.
Affording Veterinary Care *
How do you feel when you can't afford veterinary care? That is, do you feel sad, angry, scared, depressed, anxious, etc.? What do you think causes you to feel that way?
Veterinary Care in the Future *
Why does this pet need veterinary care in the future? Check all the options that apply.
Have you ever used Vouchers before? Check all that apply.
Special Circumstances *
Describe your current situation, such as how you came to lack the money to pay for veterinary care, information about a disability you have, about a health problem your pet had in the past or has now, etc.
Message to Veterinary Staff *
What message of thanks would you like to send to your veterinarian and the rest of their staff for helping your pet in the past and/or in the future?
Message to Donors *
What message of thanks would you like to say to donors for you to have Vouchers in the past and/or in the future?
Message to Staff & Volunteers *
What message of thanks do you have for One Health Organization staff and volunteers?
Please enter the best phone number to reach you during normal business hours from 8:30 am to 5:30 pm, Monday through Friday.
Please enter the best email address to use to contact you.
Choose the county where you live. If you don't know the county, click "Other" and enter your ZIP code.
Please upload a photo of your pet. We'd prefer one where you are also in the photo. If you can't have your face in the photo, then having a part of your body in the photo is fine. You can also upload a picture of a drawing or other artistic piece of your pet.
Accepted file types: jpg, gif, png, pdf. Photo Description
Please describe any of the photos you uploaded.
Clicking this helps us know that a real person entered information into this form.
This field is for validation purposes and should be left unchanged.