Veterinary Information Request Form Dear Veterinarian,To ensure that dogs are placed in the best possible care, DVGRR is seeking a veterinary reference as part of the adoption process. We appreciate your cooperation in this matter.Applicant Information* Indicates required fieldProspective Adopter's Name:* Address: City, State, Zip Veterinarian Name:* Hospital/Practice Name: Vet email:* Vet phone:* Veterinarian's CommentsNote: Information is treated with complete confidentiality.List current and/or former pet(s) under your care:How long have you cared for this clients pet(s)?Does this client provide consistent, time, and appropriate care for pet(s)?Have vaccinations been kept current?YesNoHas the client's dog(s) been heartworm tested and maintained on heartworm preventative?YesNoDo you feel this client will provide a safe and nuturing home for an adopted rescue dog?Please add any other comments you feel are relevant to evaluating this client's ability to ensure appropriate care of an adopted rescue dog:Veterinarian's Digital Signature: Date MM slash DD slash YYYY CAPTCHA Δ
