Vet Reference Check Report

Select the date the reference check was performed.
Enter your first and last name.
Enter the name of the Dobie the adopter is interested in. If unknown, enter unknown.

Adopter Information

Enter the adopter's first name.
Enter the Adopter's Last Name
Enter the Adopter's phone number. Use format: xxx-xxx-xxxx

Veterinarian's Information

Enter the Veterinarian's Name and/or the Clinic Name
Enter the full name of the person you spoke with at the Vet Clinic
Enter the veterinarian's phone number. Use format xxx-xxx-xxxx

Vaccine Information

Is current dog(s) current on Rabies?
Is current dog(s) current on DHLPP/DA2PP?
Is current dog(s) current on Corona Virus?
Is current dog(s) current on Bordetella?

Heartworm Preventative Information

Is current dog(s) on Heartworm Preventative?
You can select more than one, one at a time.
Select the date when was the last Heartworm test done
Enter the date when Heartworm Preventative was last purchased

General Questions

Enter the length of time the applicant has been a client of the vet clinic.
Select yes or no.
Select yes or no
Select yes or no
Select yes or no
Enter any additional comments.


I certify that I contacted the veterinarian's office described above and I spoke with a representative of that office.  I further certify that the above information is true and correct. 

If you are using a phone or tablet to complete this application, simply sign your name below. If you are using a computer, use your mouse to write your name below.

Sign here

Enter today's date.

Click submit once. It may take up to 30 seconds for the screen to change. Do not click submit more than once.