SNSI - Vet Reimbursement Form

Please select your clinic name

Clinic Name

If your clinic is not listed please contact SNSI Email: VetBills@petfriendlyservices.org

Veterinary Clinic Address

Street Address *

City *

State *

ZIP/Postal Code *

Send my check to this address.

The address above is what we have on file. If this is not the current address of the clinic please contact us with updated contact information. Email: VetBills@petfriendlyservices.org

Contact SNSI

There seems to be an issue finding the address on file for this clinic. Please contact SNSI as their assistance will be needed to proceed. By email at VetBills@petfriendlyservices.org

Please include the certificate number

Certificate Number

Cancellation/No show reimbursement.

Continue

Contact SNSI

Please ensure the certificate number is correct. If it is, please contact SNSI as their assistance will be needed to proceed.

Certificate Expired - Contact Pet Friendly Services

Please ensure the certificate number is correct. If it is, please send an email to info@petfriendlyservices.org with the expired certificate number and we will get it adjusted so that you will be able to enter it. Thank you and our apologies for the inconvenience.

Pet Information

Pet Name *

Pet Type *

Dog

Cat

Pet Sex *

Male

Female

Hermaphrodite

Age *

Breed *

Pet Weight (in lbs)*

This is a feral/free roaming cat

In heat/Pregnant

Procedure Information

Please complete this information in its entirety to ensure proper reimbursement.

Surgery Date *

Special Circumstances? *

Additional Charges

Additional Information

Comments/Notes

Invoice Number

Total Amount

Reimbursement Rate *

Total Reimbursement Amount

The Veterinary Clinic Address must be verified