Veterinary Diagnosis

To Treating Veterinarian: Your clients have contacted SamUrgency, Inc., to help assist with treatment costs for their Samoyed. Please understand that there is no guarantee of assistance from SamUrgency and that this form will be used to help determine if we are able to assist these clients. If you have questions about the status of this application, please contact us. Thank you for answering these questions honestly and completely.

  • Veterinary Information

    By submitting this information, I attest that this treatment, cost and prognosis are stated accurately.