Important Notice for Veterinary Surgeons:
You have been asked to complete this form because the owner of a dog in your care has applied for a grant to help cover the costs of their dog’s cancer treatment.
The Medical Eligibility Application Online Form
Downloadable forms
If you prefer to submit a physical form or need a copy for your records, please download the appropriate form below.
Once completed, send them to [email protected]
Medical eligibility form for dog’s First Consultation Application
This form should be completed by the veterinary surgeon at the primary care practice for funding assistance related to the dog’s initial consultation at a specialist cancer centre.
Medical eligibility form for dog's Cancer Treatment Application
This form should be completed by the specialist veterinary surgeon at the referral treatment centre for funding assistance related to the dog’s ongoing cancer treatment.
Explanation for the dog owner:
The Medical Eligibility Form must be completed by the veterinary surgeon responsible for the dog’s care.
- If you are applying for an initial consultation at a Cancer Treatment Centre, the form should be filled out by your regular veterinarian who is recommending the consultation at the Specialist Cancer Treatment Centre.
- If you are applying for funding assistance for your dog’s cancer treatment, the form should be completed by the oncologist who last examined your dog and recommended the proposed treatment at the Specialist Cancer Treatment Centre.