Neel Veterinary Hospital Dog/Cat Blood Donor Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Neel Veterinary Hospital Dog/Cat Blood Donor Application - Oklahoma City

Thank you for your interest in your pet becoming a part of the Neel Veterinary Hospital Animal blood donor program! In order to donate blood, your pet has to meet certain criteria. The form will help us determine if your pet may be a good candidate and be eligible to move to the next steps in the process. If we determine that your pet may be a good candidate, we will contact you. The next steps would be to confirm medical records and draw a blood sample to Type your pet's blood. If your pet is determined to be a Blood Donor, your pet must be able to be brought in every 4 to 8 weeks for a blood donation until they reach the age of 7. Your pet will need to be between 1 and 6 years old at the time of application. We would prefer donor families live within 50 miles of the OKC metro area.

Benefits for qualified blood donors are free initial blood testing, a free 8lb bag of Royal Canin food for each donation, free blood products equal to the amount they donated if the need arises and free tag stating that your pet is Blood Donor.

We will sort through applications and contact those who meet our criteria. Please do not contact us to inquire about the status of your application as we will only contact those who are eligible to move forward in the process.

Email *

Pet Owner First & Last Name *

Pet's Name *

Mailing Address *

Phone Number *

Is your pet a dog or cat? *

Dog

Cat

Are you the original owner of the pet? *

Yes

What does your pet weigh? *

How old is your pet? *

Is your pet spayed/neutered? *

Yes

Is your pet up to date on vaccines? Rabies, Bordetella, Distemper/Parvo. *

Yes

When was your pet's last heartworm test? *

YYYY

What heartworm prevention is your pet currently receiving? *

What flea/tick prevention is your pet currently receiving? *

Has your pet ever been diagnosed with any tick borne disease? *

Yes

Has your pet ever had a blood or plasma transfusion? *

Yes

Please write in your primary veterinary clinic's name so that we may call to confirm medical history. *

Do you ever pet sit or foster other animals in your home? *

Yes

Has your pet ever been used for breeding purposes? *

Yes

Has your pet ever been pregnant? *

Yes

Has your pet been sick or had surgery within the last 2 weeks? *

Yes

Has your pet ever been diagnosed with a bleeding disorder? *

Yes

Has your pet ever been diagnosed with anemia, cancer or other blood disorder? *

Yes

Has your pet ever been diagnosed with chronic heart/liver/kidney/seizures/diabetes? *

Yes

Has your pet ever been outside of the United States? *

Yes

If you have a cat, are they indoor only? *

Yes

N/A

Is your pet on any medication currently? (Other than flea/tick/heartworm prevention) *

Yes

Please list those medications.

Does your pet have a heart murmur? *

Yes

Does your pet have any food allergies? *

Yes

Does your pet have a good temperament? *

Yes

Are you able to travel to Neel Veterinary Hospital every 4 to 8 weeks for blood donation? *

Yes

Any questions or comments?

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms