Documents sent to IMOM must have all personal account information blacked out.  This includes social security number, bank account and bank routing numbers as well as any other personal account numbers.

If account numbers are visible IMOM will immediately destroy all of the documents you have sent.  If this happens you will be required to send all documents again.

Fax Cover Sheet

We have a PDF document you'll need to print and complete to send with your documents.  It is also helpful to use for a check list.

Click here.

Veterinarian's pet information form
(VPIF)

IMOM needs to verify that your veterinarian is willing to work with our payment policies.  Please print our 3 page letter and give it to your veterinarian. 

Ask your veterinarian to complete the form on page 3 and fax it to IMOM with the estimate - or give it to you so you can send it. 

The form is titled "Veterinarian's Pet Information Form" (VPIF)

Click here to download and print the 3 page letter. 

(To open and print this 3 page letter you will need Adobe Reader.  If you do not have Adobe Reader you can download it.  It's free.  Click here to download Adobe Reader).

Written estimate

IMOM requires a written estimate from the veterinarian who will be providing the care your pet needs.  The estimate must be on your veterinarian's letterhead and faxed to IMOM prior to completion of your application. 

IMOM strongly advises applicants to get a copy of the estimate from their veterinarian so it can be sent at the same time other documents are sent.

The estimate should include all of the following:

1. A complete breakdown of the costs including any follow-up care.  Follow up costs not included in your original estimate will not be considered and you will be responsible for those costs.
    

2. If your pet has not been spayed or neutered we need to know if it can be safely done at the time of other treatment.
    

3. The cost to have your pet spayed or neutered if they have not already been spayed or neutered.
    

4. The urgency of your pet's condition.  How soon should this treatment be completed?
    

5. Your pet's general health and prognosis.

Our fax number is 630-214-8952

Care Credit

IMOM has no affiliation with Care Credit.

As previously stated in step 3 you may be required to apply for Care Credit before submitting an application to IMOM.  What determines whether or not this is a requirement for you depends on whether or not your veterinarian accepts Care Credit.

If you are approved for Care Credit IMOM will need a copy of your approval notice.  We will also need to know the amount of credit you have remaining.

If you are not approved for Care Credit IMOM will need a copy of your denial notice.

***Approval from Care Credit does not necessarily mean you will not qualify for financial aid from IMOM.  You are invited to continue with our application process.**

Our fax number is 630-214-8952

Proof of income for household

**This is important.  Read carefully**

Documents sent to IMOM must have all personal account information blacked out.  This includes social security number, bank account and bank routing numbers as any other personal account numbers.

If account numbers are visible IMOM will immediately destroy all of the documents you have sent.  If this happens you will be required to send all documents again. 

IMOM requires two proofs of income (POI) from all adult household members.

You should keep in mind that IMOM does not base decisions only on income in case review.  We understand there can be extenuating circumstances and we are willing to discuss that with an applicant.

proof of income is required from all Adult household members:

For persons who are required by IRS to file a tax return:

1. If you are required by the IRS to file a tax return you must provide IMOM with a complete copy of your latest tax return.
    

2. Copies of 3 most recent bank statements.

For persons who are not required by the IRS to file a tax return. 

IMOM needs two proofs of income.  You may send any combination from the list below:

1. Copies of last three pay stubs.
    

2. SSI benefits letter.
    

3. Unemployment benefits letter.
    

4. W-2 from employer/s.
    

5. 1099 from employer/s.
    

6. Copy of three most recent bank statements.  The statement can be from either a checking or savings account. IMOM needs bank statements from all household members - from all household members

On occasion we may need additional documents after your application has been submitted. You will be advised by your case worker if this will be necessary.

Our fax number is 630-214-8952

Documents sent to IMOM must have all personal account information blacked out.  This includes social security number, bank account and bank routing numbers as any other personal account numbers.

If account numbers are visible IMOM will immediately destroy all of the documents you have sent.  If this happens you will be required to send all documents again.