NSNRT Training Preparation Form
Organization Details
Now that you’re about ready to open, where is your clinic located and which name did you settle on?
Organization Name
Your answer
Clinic Name
If different from the organization
Your answer
Clinic Street Address
Your answer
Clinic City
Your answer
Clinic State
Clinic Zip Code
Your answer
Clinic Country
Clinic Email Address
Your answer
Clinic Phone Number
Your answer
Clinic Website
Your answer
Opening Date
When will be your first week of opening following your NSNRT training week in Asheville?
Your answer
Transport Program
Do you intend to implement a transport program?
Clinic Software
Which software do you intend to use in your clinic?
Full Attendance
Is the entire team that will be involved with the clinic coming to Asheville (admin and medical)? Y/N. if no, who is not coming and why?
Not Full Attendance Reason
If you answered "no" to the above question, please explain why.
Your answer
Decision-Making
Is a person who is able to make decisions on behalf of the clinic related to budgets, staffing, operations, policies, and procedures attending the training?
Director Attendance - Return Training
Please confirm that your director (who oversees the clinic) is available during our return training at your clinic to meet with our team at the beginning and end of each day, and is available onsite during the training days, in case questions arise.
Veterinarians
One or two veterinarians may attend. If you have two veterinarians, they will share the surgical load. Leave any team members that do not apply to you blank. Staff members with asterisks are mandatory for training.
Veterinarian #1 First Name
Your answer
Veterinarian #1 Last Name
Your answer
Veterinarian #1 Email
Your answer
Vet #1 Background
Briefly describe your veterinarian's background.
Your answer
Vet #1 S/N Surgeries
How many total spay/neuter surgeries has your veterinarian performed?
Vet #1 Comfort
How many surgeries (equal mix of patients) is your veterinarian comfortable performing in 6-hours of surgery?
Vet #1 Drug Protocol
What drug protocol does your veterinairan intend to use?
Your answer
Vet #1 Training Objectives
Is there anything specific your veterinarian would like to see, do, or practice while in Asheville?
Your answer
Veterinarian #2 First Name
Your answer
Veterinarian #2 Last Name
Your answer
Veterinarian #2 Email
Your answer
Vet #2 Background
Please briefly describe your second veterinarian's background (if applicable).
Your answer
Vet #2 S/N Surgeries
How many total spay/neuter surgeries has your second veterinarian performed (if applicable)?
Vet #2 Comfort
How many surgeries (equal mix of patients) is your second veterinarian comfortable doing in 6-hours of surgery (if applicable)?
Vet #2 Drug Protocol
What drug protocol does your second veterinarian intend to use (if applicable)?
Your answer
Vet #2 Training Objectives
Is there anything specific your second veterinarian would like to see, do, or practice while in Asheville (if applicable)?
Your answer
Support Staff
At least two medical support staff such as a veterinary technician and veterinary assistant must attend, but three medical support are welcome. Leave any team members that do not apply to you blank.
Technician First Name
(Or lead medical support person's first name)
Your answer
Technician Last Name
(Or lead medical support person's last name)
Your answer
Technician Personal Email
Your answer
Technician Background
Briefly describe your technician/lead medical support person's background.
Your answer
Technician Substance Experience
Has your technician/lead medical support person handled controlled substances and managed a drug log before?
Technician Intubations
Has your technician/lead medical support person performed intubations before?
Medical Staff #2 First Name
Your answer
Medical Staff #2 Last Name
Your answer
Medical Staff #2 Personal Email
Your answer
Medical Staff #2 Position
What position does your second medical staff member fill?
Medical Staff #3 First Name
If applicable
Your answer
Medical Staff #3 Last Name
Your answer
Medical Staff #3 Personal Email
Your answer
Medical Staff #3 Position
What position does your third additional medical staff fill (if applicable)?
Medical Staff #4 First Name
If applicable
Your answer
Medical Staff #4 Last Name
Your answer
Medical Staff #4 Personal Email
Your answer
Medical Staff #4 Position
What position does your third additional medical staff fill (if applicable)?
Administrative Staff
The administrative staff MUST include the person who is ultimately responsible for all decision-making at the clinic. In most cases this will be the executive director, but in a larger organization it may be an operations director. Up to two additional administrative support staff are welcome.
ED First Name
Either executive director's or director of clinic operations.
Your answer
ED Last Name
Your answer
ED Email
Your answer
ED Cell Phone
Cell phone of program participant (to reach in case of emergency)
Your answer
ED Background
Briefly describe your executive director/director of clinic operations' background.
Your answer
ED Objectives
We will offer you a full week of training on all aspects of clinic operations. However, are there any specific topics on which the executive director/director of clinic operations would like to focus?
Your answer
Admin Staff #2 First Name
First name of your second administrative staff member (if applicable)
Your answer
Admin Staff #2 Last Name
Last name of your second administrative staff member (if applicable)
Your answer
Admin Staff #2 Personal Email
Your answer
Admin Staff #2 Position
What position does your second administrative staff member fill (if applicable)?
Admin Staff #3 First Name
First name of your second administrative staff member (if applicable)
Your answer
Admin Staff #3 Last Name
Last name of your second administrative staff member (if applicable)
Your answer
Admin Staff #3 Email
Your answer
Admin Staff #3 Position
What position does your third administrative staff member fill (if applicable)?
At Your Clinic
Training will begin at 7:30 am Monday and finish end-of-day Thursday or Friday morning.

The NSNRT training team will be there to guide you through your opening week. Onsite training will start Monday morning of Week Two through Friday. Ideally, the Humane Alliance team will be at your clinic on Friday morning for a wrap-up session. However, they may conduct the wrap-up on Thursday depending on the Friday travel arrangements.

Open Days
During the week that Humane Alliance will be onsite, what days will your clinic be open?
Required
Start Time
What will be your start time on the Monday morning/first day of the week?
Your answer
Training Address
What is the address of the clinic our team will be visiting?
Your answer
Comments
Please add any details that you think might be of benefit to know ahead of time.
Your answer
Travel For Humane Alliance Team
The Humane Alliance team members will make their own travel arrangements. However, we welcome your input!
Airport Suggestions
Is there more than one option? Is it easier to fly to a different city and have a short drive?
Your answer
Hotel Suggestions
Within 20 minutes of clinic, safe neighborhood. Hampton Inn, Holiday Inn Express, Comfort Suites, etc.
Your answer
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