Find Partnered Vets Accepting Ellie's Rainy Day Fund Assistance

In the case of an emergency, please contact MedVet and notify them you are making an Ellie’s Rainy Day Fund referral. Please follow-up the call with this MedVet Referral Form

Once you have successfully submitted this form, you will received a return copy via email for your records. Any questions or difficulties please call Juli Burnell 937-657-6878

If you plan to send the pet to Medvet immediately, please have the referring veterinarian call and speak to the ER vet or tech FIRST. Occasionally the client needs to be routed to a different location. Notify them you are making an Ellie’s Rainy Day Fund referral. Please follow up the call with submission of this Form in a timely fashion. It will get your client properly in the system and alert us to call to make sure their experience is seamless.

Phone: (937) 293-2714
Email: [email protected]
This email is checked 7 days a week, multiple times per day.
Fax: (937) 293-2787

MedVet Referral

Today's Date(Required)

Member Practice

Practice Name(Required)

Referring Veterinarian(Required)

Practice Email(Required)

Patient Information

Patient Name(Required)

Patient Name

Age(Required)

Species(Required)

Sex(Required)

Male

Female

Altered(Required)

Yes

Client Information

First Name(Required)

Last Name(Required)

Street Address(Required)

Address 2

City(Required)

State(Required)

Zip(Required)

County(Required)

Phone(Required)

Email Address(Required)

Referral Information

Our goal is to keep pets and their families together; Is this pet treated as part of the family? How does the family count on the pet (examples: companion for elderly? Autistic child? Help combat anxiety? Depression? PTSD?) Will the client’s lack of available funds result in their companion animal not receiving the care necessary to maintain the best health outcome, having to be surrendered or euthanized?

Medical Reason for Referral(Required)

Date Problem Identified(Required)

If you can take a photo of the pet at the time of their visit, please do so and send it to us at [email protected]. THANK YOU!

Phone

This field is for validation purposes and should be left unchanged.