Spay/Neuter Surgical Team Training Application
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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