2025 Velvet Assistance Fund Application

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Base
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Increment
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VAF 100%
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VAF 50%
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VAF 50 Status
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Total Yearly Income* This field is required.
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Unique ID
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How did you hear about the Velvet Assistance Fund?
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Which Velvet Assistance Fund program are you applying for?* This field is required.
Appointment for a Doctor's Exam
Euthanasia
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To Apply for the Velvet Assistance Fund:

Apply for Care Credit or Scratchpay

Receive a denial and upload a screenshot or photo of denial message

Complete this application by providing income information

Receive an approval

Book a Velvet Assistance Fund appointment

The Velvet Assistance Fund (VAF) provides financial support for eligible families once per household, per year. An approved application is required before booking—repeat or unapproved applications will be denied. VAF covers the cost of a doctor’s exam only. It does not cover procedures, diagnostics, surgery, or other major services.
Appointments are released on a rolling basis one week in advance. If no times are available, please check back regularly for newly released slots.

Important: Missing a scheduled VAF appointment will make your household ineligible for further VAF use for one year from the missed appointment date.
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Please select which application you completed and were denied a line of credit for today:* This field is required.
Care Credit
Scratchpay
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Please upload proof of denial from Care Credit or Scratchpay here:* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Tell us about your pet's condition and your reason for seeking an appointmentIf your pet is experiencing an immediate emergency, go directly to Dovelewis and check in at the 24/7 Emergency Room at 1945 NW Pettygrove Street
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How did you hear about this program?* This field is required.
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Your Name* This field is required.
First Name
Last Name
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Pet's Name* This field is required.
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Pet's Age* This field is required.
Number
Years
Please Select
Years
Months
Days
Unit of Time
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Pet's Sex* This field is required.
Male Intact
Male Neutered
Female Intact
Female Spayed
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Pet Breed* This field is required.
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Phone Number* This field is required.
Please enter a valid phone number.
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Email* This field is required.
example@example.com
Confirm Email
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Social Security Number* This field is required.
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Total Number of People In Household
1
2
3
4
5
6+
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Government Issued ID Number* This field is required.
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Government ID Photo Upload* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Occupation* This field is required.
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Employer* This field is required.
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Total Household Income* This field is required.Household income is defined as any income that you, your spouse, domestic partner, etcetera receives.
Total Household Income
Monthly
Please Select
Monthly
Yearly
Weekly
Bi-Weekly
Period
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How much are you able to contribute to your bill?* This field is required.
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Marital Status* This field is required.
Single
Married
Divorced
Common Law or Civil Partnership
Prefer not to answer
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Demographic Information

The following questions are designed to help us better understand the community we serve and will not affect any eligibility for financial assistance or agreements.
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What gender do you identify as?* This field is required.
Male
Female
Non-Binary
Prefer Not to Say
Other
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Which of the following describes your racial or ethnic identity? Please select ALL that apply.* This field is required.
American Indian or Alaska Native
Asian
Black or African American
Latinx or Hispanic
Middle Eastern/North African
Native Hawaiian or Pacific Islander
White
Other
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How Old Are You?
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65-74 years old
75+ years old
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Do you receive deliveries from Meals on Wheels People?
YESNO
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Are you currently or have you ever served as a member of the United States Armed Forces?* This field is required.
Yes
No
Prefer not to answer
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Add Dependents (if any)
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Velvet Assistance Fund Application* This field is required.This fund may be used to access funding for end-of-life care, which includes compassionate euthanasia and general cremation. Please see the full terms and conditions below.
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Velvet Assistance Fund Application* This field is required.This fund may be used once per year per household for an appointment for a doctor's exam. Repeat applications will be denied. Please see the full terms and conditions below.
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If you financially qualify for the Velvet Assistance Fund, the next step will be to medically qualify.

VAF Eligible Cases must be outpatient (non-hospitalized) emergencies. A DoveLewis veterinarian must examine the patient and confirm that the animal has a good prognosis without fatal injuries, unrecoverable symptoms and or require significant follow-up care or diagnostics. Common examples of conditions that are covered by the the Velvet Assistance Fund are: Eye Ulcers, Abscesses, Lacerations.

If you are qualified for 50% coverage using the Velvet Assistance Fund, you must pay 50% of the final balance at time of discharge in order to use VAF.
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Signature* This field is required.
Clear
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VAF Status:Will not be client facing at launch, used to store data
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vafThru
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