Team Training Application Form
Clinic Name
Your answer
Clinic City
Your answer
Clinic State/Province
Your First Name
Your answer
Your Last Name
Your answer
Title
Your answer
Contact Phone
Your answer
Contact Email
Your answer
Clinic Operations
Opening Date
When did your clinic open?
Your answer
Annual Surgeries
How many surgeries did you complete last year?
Your answer
Average Daily Surgeries
In the current year, what is your average number of surgeries per day?
Your answer
Patient Mix
What percentage of your patients are dogs vs. cats on a typical day?
Your answer
Clinic Staffing
What is your typical clinic staffing (i.e., 1 vet + 1 RVT + 1 vet assistant + 1 clinic manager)?
Your answer
Release
Do you release animals the same day?
Your Clinic Set-Up
# Prep Tables
How many prep tables do you have?
Your answer
Anesthesia Machines (Prep)
Is there an anesthesia machine at each prep table?
# Surgical Tables
How many surgical tables do you have?
Your answer
Anesthesia Machines (Surgery)
Is there an anesthesia machine at each surgical table?
Recovery Location
Where do the patients recover immediately after surgery? Please be specific, i.e., on beach in prep then back to their holding cages
Your answer
Kennel Space: Dogs
How many dogs can your clinic hold?
Your answer
Kennel Space: Cats
How many cats can your clinic hold?
Your answer
Goals
Goals & Priorities
What are your goals and priorities for this training?
Your answer
Staff For Training
Describe who you would like to send for training. Team Training is designed for 4 people. For example 1 vet + 3 medical support staff or 2 vets + 2 medical support staff. Note if you are sending 2 veterinarians, they would share the surgical load and each get 1/2 the total surgeries for the day.
Medical #1 First Name
Your answer
Medical #1 Last Name
Your answer
Medical #1 Email
Email address of program participant (to reach in case of emergency)
Your answer
Medical #1 Phone
Cell phone of program participant (to reach in case of emergency)
Your answer
Medical #1 Position
Medical #2 First Name
Your answer
Medical #2 Last Name
Your answer
Medical #2 Email
Your answer
Medical #2 Position
Medical #3 First Name
Your answer
Medical #3 Last Name
Your answer
Medical #3 Email
Your answer
Medical #3 Position
Medical #4 First Name
Your answer
Medical #4 Last Name
Your answer
Medical #4 Email
Your answer
Medical #4 Position
Additional Comments
Do you have any additional comments or questions about your team or the training itself?
Your answer
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