Veterinary Application – Balfour's Friends Foundation

Step 1: Before You Start

Veterinary clinics should only complete this form if:

The treatment that the pet requires:

- is essential/non-elective. BFF does NOT fund elective procedures such as spaying/neutering, vaccinations, or routine examinations.
- will result in a survival rate of 50% or greater.

The pet owner:

- lives on Vancouver Island, and
- confirms that they meet BFF’s income eligibility.

Note: BFF does not provide assistance for animals under the care/guardianship of foster homes or pet rescue organizations.

STEP 2: ENSURE THAT THE PET OWNER HAS READ THE INFORMATION SHEET

If the pet owner has not read the information sheet, click here and provide it to them.
Collect proof of income and pet photo (optional) from the pet owner.

If any of the attachments are in paper form, they will need to be scanned (or a legible photo taken of them) before submitting to BFF.

BFF is committed to safeguarding all personal information in accordance with British Columbia’s Personal Information Protection Act and our BFF Privacy Policy.

STEP 3: Complete the vet clinic form below and submit to BFF

Complete the form below in full. (You may attach a detailed estimate with some of this information if that is your preference.)
When directed, attach proof of income eligibility and any additional attachments provided by the pet owner such as pet photos.
Click submit.

SECTION A: Contact Information

Name of Clinic Contact Person(Required)

Phone(Required)

Email(Required)

Preferred method for transfer of funds:(Required)

Cheque

E-Transfer

Email address for e-transfer(Required)

SECTION B: Clinic Information

An estimate containing the clinic information has been attached to this application

Yes

Name of Vet Clinic/Hospital(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

SECTION C: Client & Pet Information

An estimate containing the client and pet information has been attached to this application

Yes

Name of Client(Required)

First Last

Client Address

Street Address Address Line 2 City Province Postal Code

If the pet owner lives in the Greater Victoria region, which municipality do they live in? (Optional - this information is of assistance to BFF when applying for grants.)

Name of Pet(Required)

Type of Animal(Required)

Breed (if applicable)

Age

Does the client live with a partner (i.e., married or common-law)?(Required)

Yes

How many children or other dependents live in the household?(Required)

SECTION D: Veterinary Care Required

What is the reason for this request? (i.e., what is the medical issue and treatment/procedure required?)(Required)

What is the prognosis/survival expectancy for the pet with the recommended treatment?(Required)

*Please note that the animal must have a 50% or greater chance of survival following the recommended treatment in order for BFF to provide funding.

Estimated total cost of the treatment/ procedure(Required)

Please detail any other additional funding, if applicable. For example, from other charities, loans, fundraising, family, etc.

Outstanding balance (after other sources of funding have been applied)

Any other information you think we should know?

SECTION E: Client Attachments

Attach:

Estimate (optional)
Proof of income eligibility
Pet photo(s) - optional

Files(Required)

Drop files here or

Max. file size: 36 MB.