Veterinary Treatment & Assessment Form for Pet Assistance Program (PAP) Client's name Phone number Email Animal name Species Breed Age Sex Veterinary clinic name Veterinarian name Contact number Date of assessment Presenting condition / reason for visit Diagnosis How urgent is it for the treatment to commence? If left untreated, how much of an impact does this have on the animal's welfare? Is the condition: Manageable Treatable Curable Palliative care only Prognosis (short explanation) Treatment options (if there is more than one option, please include all options) Are there any possible complications of the treatment? Estimated cost of treatment Is the client able to cover any of the costs? If yes, how much? Cost breakdown (if available) Additional comments File Upload Drop a file here or click to upload Choose File Maximum file size: 10MB Submit
