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LABMED Application Form

LABMED IS UNABLE TO FUND DOGS WHO HAVE OWNERS. Please do not submit an application if this dog is your pet.
Instructions:
Please fill out the form below completely; if you are unable to answer a question, please enter "not yet known" or give us an estimate. You must also submit a picture of the dog, either via e-mail to Donna Harrison or snail mail to the address given below. Please visit this page for more information about submitting pictures. Once the application is submitted, you will receive a confirmation that we received your application within 48 hours. The length of time it takes for us to make a decision on funding varies a great deal. If you have any questions or problems submitting this form, please email us.

Any misrepresentation of the facts or provision of false information about the case will result in immediate closure of the application and denial of funding for any future applications.

If you have any questions or problems submitting this form, OR IF YOU DO NOT HEAR FROM US WITHIN 48 HOURS, please email us or call 972-208-2470.

If this is a life or death emergency and you need a response from us within 24 hours, then YOU need to make sure we are provided with the following:

The vet must be available to speak with a LABMED representative.
You must get a picture of the dog to us within 24 hours. You can e-mail a picture to Donna Harrison. If you are not able to e-mail one, but choose instead to send one by overnight mail, the address is

LABMED, Inc.
3941 Legacy Drive, Suite 204, #A115
Plano, TX 75023
In the medical section of the application, please give us as much detail as you can on the nature of the emergency treatment needed and information on what treatment has already been given.

IF THIS IS YOUR PET: DO NOT complete this application form if you are this dog's owner. LABMED is NOT able to consider applications for assistance for established pets (i.e. dogs who have been adopted for longer than two weeks or dogs who are not in a rescue situation). If you have any question about this, please see our Funding Guidelines, number 11 A and B.

For more information about various medical conditions, including information about alternatives to surgery for hip dysplasia, please visit links you will find on this page: http://www.labmed.org/lnk_medicalsites.html

We appreciate your understanding that LABMED is not able to consider helping with funding for Labs who are established pets.

If this dog is not your pet, please continue:

Contact Information

Contact Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
Telephone number:
E-mail:
Additional Contact Info:

Dog Information

If you are applying on behalf of a rescue group or other organization, please name the organization:

Name of Rescue Dog:
(if the name is unknown, please give the dog a name)

Sex of dog?
Male
Female

Color of dog:
Chocolate
Black
Yellow

Approximate weight:

Approximate age:

Has the dog been neutered/spayed?
Yes
Not yet

If you are the owner of this dog, DO NOT complete this application. Click here for further information

If you are not the owner of this dog, or if you have owned the dog for less than two weeks, please continue:

Does this dog have any identification tags/tattoos or microchips?

What attempts have been made to contact the owner of the dog?

Has the dog's breeder (if known) been contacted?
Breeder unknown
Known, but not contacted. Why?
Contacted. Breeder's response:

How did you find this rescue dog?

Date of Rescue

Do you know anything about this dog's background?

Has this dog shown any animal- or human-directed hostility? Please describe.

What are the foster plans for this dog:
I am fostering and will continue to do so until adopted.
Someone else is fostering and will continue to do so until adopted.
I hope to adopt this dog.
I have already adopted this dog.
Date of Adoption
No foster plans finalized as yet.
Other

How will you be sending the photo?
e-mail
overnight mail
priority mail
regular mail

Medical Info

Is this a life or death emergency?
Yes
No

Please provide a full description of the rescue dog's illness or injury:

Dog's current location is:
Veterinarian
Clinic
Shelter
Private Home
Other

Name of treating Veterinarian:
Name of Clinic/Practice:
Address:
City:
State:
Postal/Zip Code:
Telephone number:
Fax number:
E-mail address:

What is the dog's medical diagnosis?

What is the recommended course of treatment?

What is the dogs prognosis?

What is the estimated cost of this treatment?

Was a rescue discount requested?
Yes No

If yes, will one be granted?
Yes No

Has treatment already begun or been completed on this dog?
Yes No

If so, on what date?

Funding Information

How did you find out about LABMED?

Did you contact any local Labrador Breed and/or Rescue organization?
Contacted
Not contacted
N/A

If yes, please identify the organization, give contact person's name, and summarize their response to your situation:

Have you contacted any other organizations regarding this Lab or Lab-Mix? If yes, identify organization, give contact person's name and information, and summarize their response to your situation.

How much have you already spent on this dog's medical treatment and care since rescue?
LABMED funds are always limited, and we try our best to stretch them as far as possible to help as many Labs as we can. We hope that you will be able to pay at least a portion of this bill. How much will you or your rescue group be able to contribute to this bill?
Please specify the amount you are requesting from LABMED:

NOTE: Please enter all funds in US Dollars. To convert funds, use the Universal Currency Converter.

Is the total of the two amounts above different from the estimated cost of treatment?
Yes
No
N/A

If yes, please explain.

If you are unable to contribute to this dog's care, please explain:

I have read LABMED's Mission Statement, Application Procedures, and Funding Guidelines and if funding is approved I agree to abide by all rules and contingencies set forth by the organization.
Yes
No

If you have any questions or problems submitting this form, OR IF YOU DO NOT HEAR FROM US WITHIN 48 HOURS, please email us or call 972-208-2470.

DO NOT SUBMIT THIS APPLICATION IF YOU ARE THE OWNER OF THIS DOG. We are unable to grant funds for dogs who have owners.

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Last Updated: Fall 2015