Need Application Form

Concierge Membership Support

For those who feel strained financially by these options, we will continue to accept applications for integrative grants through the Royal Animal Health University Foundation (501c3). If you feel that this is an option you’d like to explore, please fill out the Need Application Form, which can be found below. Applications will continue to be considered on a case-by-case basis, as limited funds are available.

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Name *

First

Last

Pet(s) Name(s) *

Pet(s) Age(s) *

Any specific health condition/circumstance for Pet(s): *

Email *

Phone *

Reason for needed support:

Support Amount requested: *

• $100
• $250
• $300 (Standard Wellness Concierge)
• $500
• $750
• $1000
• $1500
• $2000 (Extended Wellness Concierge)
• $2000 plus fees for additional pets
• Other Amount

Number of additional pets:

Amount requested:

Agreement & Signature

I affirm my reason(s) for needed support, and that I believe obtaining integrative medical care from RTVC is nevertheless a priority for me and my pets. Unfortunately, Concierge Membership for integrative vet care at RTVC would be unattainable without support.

Signature *

Clear Signature

Date *

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