Veterinary Grant ← BackYour application has been sent Available to individuals who reside in the Mon Valley area and need assistance paying for an exam or dental procedure (cleaning and extractions). These grants are only available at veterinary providers who are sponsors of Mon Valley Paws. Riverside Veterinary Hospital, PC (Gold Paw) – 512 S 2nd Ave, Elizabeth, PA 15037 West Newton Animal Clinic (Gold Paw) – 114 Mt Pleasant Rd, West Newton, PA 15089 Monongahela Animal Hospital (Silver Paw) – 321 Hazel Kirk Rd, Monongahela, PA 15063 The maximum amount of the exam grant will be $250 to cover an exam, testing, vaccinations or one-time prescriptions. The maximum amount for the dental procedure grant will be $500 to cover cleaning and any necessary extractions. Payment will be sent to your Vets office. Updates regarding the status of your application will be sent via email. If you don’t respond to requests for additional information, your application will not be processed. Name(required) Street Address(required) City(required) Zip Code(required) Phone Number(required) Email Address (required) Your Age(required) Total Annual Gross Household Income (wages, interest, investments, and other income sources before taxes)(required) Select one option Under $20,000 $20,000 to $39,999 $40,000 to $49,999 $50,000 to $59,999 Over $60,000 Number of Individuals in Household(required) Vet’s Name(required) Vet’s Address(required) Vet’s Phone Number(required) Pets Name(required) What Type of Pet? (required) Select one option Dog Cat Which Grant are you applying for?(required) Select one option Vet exam (exam, testing, vaccinations or one-time prescriptions – $250 Maximum) Dental Procedure (cleaning and extractions – $500 Maximum) Information you want considered regarding your application? Do you authorize your vet to share information with the Mon Valley Paws representative regarding the nature of your appointment and resulting diagnosis?(required) Select one option Yes No Signature (Enter full legal name) – I verify all information entered on this form is correct(required) Date Signed (YYYY-MM-DD)(required) By submitting this grant application, you will not hold mon valley paws responsible for any misdiagnosis, treatment, or future illness incurred at this appointment or in the future while you are the pet owner. You ALSO AGREE THAT YOU ARE responsible for any charges from your vet exceeding the maximum amount of the grant. SubmitSubmitting form Δ
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