Live Like Roo Foundation Medical Application

Cancer SUCKS. We've been in your shoes, and we'd like to help. Please read the following carefully, we'll help determine if you're eligible and help guide you through the process.

The Live Like Roo Foundation provides financial assistance to help cover healthcare costs related to cancer treatment in the form of grants that are awarded on a monthly basis after a complete review of this application and the relevant medical records.

To qualify and be considered for a grant, your pet must have a confirmed cancer diagnosis. (The board reserves the right to assist non confirmed cases, based on medical records and an established treatment plan, to confirm suspected diagnosis.) We will also need copies of all relevant medical records. Once you've completed this application, you will need to send an email to medical@livelikeroo.org, with medical records showing a cancer diagnosis AND financial records (estimates, invoices, etc.)

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Email *
Name *
If you are applying for or with a rescue, shelter or other foundation, please sign below that your taxes, licenses and state regulations are current and in good standing.
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Phone Number *
Address

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Pet's Name *
Tell us about your pet *
Date of Diagnosis
Your Pet Is... *
Your Pet is a *
What breed is your pet?  *
Gender *
If your pet spayed/neutered?  *
Have you experienced any financial hardships? Please explain *
What is the medical diagnosis for your pet? *
Has your pet previously been diagnosed with cancer? *
Veterinarian's Name *
Veterinarian's Phone Number *
Vet Clinic/Hospital Name *
Vet Email *
Are you seeking the care of a specialist (ie oncologist) or any other professional?  *
Please list any other organizations you have contacted. *
That's it! If you need to check your submission, please use the back button or reset the form to start all over. You will receive an email confirmation from us where you can respond with the relevant medical records. 

**BY SUBMITTING THIS FORM, I CERTIFY THAT THE INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND I WILL SEND ALL RELEVANT MEDICAL RECORDS TO MEDICAL@LIVELIKEROO.ORG. LLRF MAY USE YOUR PET PHOTOS AND PET DIAGNOSIS ON SOCIAL MEDIA. IF YOU DO NOT WANT US TO USE IT PLEASE EMAIL SARAH@LIVELIKEROO.ORG

PLEASE ELECTRONICALLY SIGN YOUR NAME BELOW. 
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