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Veterinarian Reference
The
veterinarian who fills
out this form will not
be held liable for
opinions expressed
within this form. If you
currently do not have a
veterinarian, you may
ask a veterinarian who
will be working on your
animal(s) to fill out
the form stating that he
or she is willing to
work on your animal(s).
The purpose of this form
is so that APC will know
that you have a
veterinarian available
whenever your adopted or
fostered animal needs
veterinary care.
Your veterinary
reference may not be a
immediate family member
and it also may not be
the same person who
fills out any other
reference form(s) for
you.
To be completed by
adopter/foster
applicant:
Name:
_____________________________________________________
Address:
___________________________________________________
Phone:
____________________________________________________
To be completed by
veterinarian:
Name:
_____________________________________________________
Address:
___________________________________________________
Phone:
____________________________________________________
How long have you been
treating the applicant’s
animals?____________
If you have not
previously worked with
the applicant's animals,
after speaking with the
applicant, would you be
willing to work with any
equine he/she may adopt
or foster from Animal
Protection Coalition,
Inc.?
Does the applicant keep
his/her animals current
on their vaccinations
and other health care?
Describe your impression
of the care and
condition of the animals
the applicant currently
owns:
Do you think the
applicant would make a
good foster or adoptive
home for an animal from
Animal Protection
Coalition, Inc.?
Why or why not?
Signature
Date
Thank you for taking the
time to complete this
form!
Please return to:
Animal Protection
Coalition, Inc.
916 S Prairie Ave
Frankfort, IN 46041
(765) 659-5209
Fax (206) 338-5604
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