Vaccine assistance helps protect pets when their owners are experiencing homelessness, domestic violence, or other temporary hardships. At Together Furever, we provide support to ensure pets receive essential vaccinations while staying safe and cared for.

If you need vaccine assistance for your pet, please complete the request form below. Our team will review your information and follow up as soon as possible to discuss next steps.

This program strengthens community health by protecting pets, foster homes, and the people who care for them. Vaccination is a critical part of responsible pet care, as recognized by the Nebraska Humane Society.

If you are an outreach worker, case manager, or agency submitting a request on someone’s behalf, we welcome referrals and collaboration.

You can learn more about our mission on our About Us page or reach out directly through our Contact Us page.

All requests are handled with care, respect, and confidentiality.

Owner Information

We need a little information about you to help us better fit your needs. Please complete the form to the best of your ability. The more information we have, the better we can help you and your pet.

Today's Date

Name *

First

Last

Email *

Phone *

Best contact number to reach you in case of emergency

Mailing Address

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Current Living Accomodations *

• Unhoused (Street, Car, Park etc)
• Emergency Shelter
• Transitional Housing
• Other

If you chose other please explain

Pet Information

Now we need a little information about your pet. Nothing is a deal breaker so please be as honest as you can about your pet.

Name of Pet #1 *

Type of Pet *

• Dog
• Reptile
• Cat
• Small Critters (hamsters, guinea pigs etc)
• Bird
• Other

Sex of pet *

• Male
• Female

Pet Age

Breed/Color/Markings on pet *

Has your pet been spayed/neutered? *

• Yes
• No

Name of Pet #2

Type of Pet

• Dog
• Reptile
• Cat
• Small Critters (hamsters, guinea pigs etc)
• Bird
• Other

Pet #2 Gender

• Male
• Female

Pet #2 Age

Breed/Color/Markings on pet:

Why does your pet need to be seen by a vet? *

Veterinarian Clinic Name *

If you do not have a vet, please put “none” in the field. We use this to verify shot records in the event we need to board your pet with other pets in the home.

Veterinarian Address

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

If you don’t know the exact address please put the cross streets of its location. (ie.. 72nd & Doge St.)

Does your pet(s) have previous illness or health issues we should know about? *

If so, please explain

Do any of the following apply to your pet(s)?

• Allergies
• Dietary Restrictions
• Requires Medication

Current Vaccinations of your pet(s), please check all that apply: *

• Parvovirus
• Distemper
• Parainfluenza Hepatitis
• Rabies
• Leptospirosis
• Bortadella
• Unsure/Not Vaccinated

If you are unsure please make sure your vet information is up to date so we can verify vaccinations.

Terms & Conditions

• I have read and understand the terms of contract and the terms are agreeable to me. It is understood and agreed that the terms of this vet request agreement shall be in effect for any subsequent vet visits of my pet.
• I certify this I am the legal owner of the pet.

Signature

By inputting your name above, you agree the form is filled out to the best of your knowledge. Any false information given will void any agreements made between you and Together Furever.

Date

Submit

THIS AGREEMENT is entered into between the undersigned owner of the pet and Together Furever Nonprofit. Terms and conditions are as follows: 

1. Together Furever is assisting in acquiring required vaccinations only. Any additional vaccines or medical care is the responsibility of the owner of the pet unless approved by Together Furever prior to the appointment.
2. Together Furever may use you for advertising, fundraising and other purposes to further the mission.  
3. The owner agrees to release all diagnostic information regarding veterinarian care of pet.
4. Together Furever is obligated to report any signs of abuse to pets.