BROOD Veterinary Expense Reimbursement Form

BROOD is happy to pay your veterinary expenses for your BROOD foster dog. If you have questions about reimbursement please contact Please fill out the following form and attach your vet bill/records along with the authorization for care email you received. You can attach up to three documents to this form, if you have additional documentation, please email it separately to

If you prefer to submit this form by mail, please complete this form, click on PRINT FORM and mail all documents to:

BROOD, Inc.
c/o Melinda Brown
3445 Seminole Trail, Box 248
Charlottesville, VA 22911

You may also print this form and fax it along with all supporting documents to our fax number 866-710-9471 (toll free).

*NOTE* You will be responsible for any expenses incurred without prior approval or attached email authorization.


(attach authorization email below)
Exam
Recheck Exam
Distemper (DHLPP, DA2PPV, DHPP, DA2PP, DHPPV)
Leptospirosis
Kennel Cough/Bordetella
Lyme
Rabies
Stool/Fecal
Heartworm
Blood Work
Urinalysis
X-Ray
Biopsy/FNA
Ultrasound
Spay/Neuter
Dental
Suture Removal
Wound Repair
Cherry Eye Repair
Biopsy
Mass Removal
Microchip
Glaucoma/Eye Check
Seizure
Bloat
Orthopedic Problem
Ear Infection
Wound/Injury/Abcess
Heartworm Preventative
Flea Preventative
Food
Visual Verification Image

        
* Required Responses