Vet Check Form

Please note the use of the Enter key will submit the form - use the mouse or Tab key to navigate the form fields to avoid accidentally submitting an incomplete form.

SCMR foster requesting this vet check:

Email address of SCMR foster requesting this vet check:

Please enter the email address again to confirm accuracy:

Animal potential adopter(s) interested in:

Name of applicant:

Date of vet check:

Spoke with:

Vet's name:

City:

State:

Vet's phone number:

Pet name(s), breed(s), age(s):

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1.  How long has (applicant) been coming to you?

2.  Are all pets neutered or spayed?

3.  Are all pets well-mannered?

4.  Last appointment for each pet:

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5.  Are pets up to date on vaccinations? Yes   No

6.  Are dogs heartworm checked? Yes   No

Last checked:		Type of heartworm prevention used:

7.  Have they ever had a dog / cat hit by a car? Yes   No

What happened?

8.  Are you aware of any reason we should not consider them for adoption?

9.  Do you feel that they are capable of handling a Maltese medical / grooming requirements and giving one a good home?

10.  Are there any signs of abuse or neglect? Yes   No

Why?

11.  Have they put a pet to sleep? Yes   No

Why?

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Office Comments:

Did they know the applicant? Yes No

Rescue Volunteer's Name:

Rescue Volunteer's Comments:

SCMR Appreciates Your Help!