Request For Assistance

If you need assistance for your K-9, please contact us by filling out the form below and we will get in touch.

If you have an urgent health issue please email us at info@policek9help.com so we can expedite your application.

If you are having trouble submitting your information you can e-mail it to us at info@policek9help.com. Also, contact us if you do not hear from us within a couple of days. Do not use Department or government email addresses.

Name

K9's Name

Department or military branch

Address1

Address2

City

State

Zipcode

Phone number

Do not use your department email. Use your personal email and add info@policek9help.com to your contacts so our responses don’t get blocked or go to spam.

Age of K9

Sex of K9

Male Female

Breed

Current vet contact information

Medications K9 is using

Current medical conditions

Adoption paperwork

Last Certification paperwork

Photo of K9

USPCA member

Yes No

Have you requested assistance from any other charities?

Yes No

If yes, what is the name of the charity?

Are you currently being assisted by any other charities?

Yes No

How did you find us?