Blood Donation - Screening Questions

Donor Screening

Please fill in the following form to have your pet screened as a blood donor. More information about eligibility requirements can be found on our Blood Donation page. If your pet meets all requirements, you will be contacted by our team.
First Name*
Last Name*
Email*
example@example.com
Phone Number*
Your pet's name*
Your pet's breed*
Species*

dogcat
Does your cat weigh at least 4.5 kg (10lbs)?

YesNoN/A
Does your dog weigh at least 22.7 kg (50lbs)?

YesNoN/A
Is your pet between the ages of 1 and 5 years?*

YesNo
Is your cat indoor only?*

YesNoN/A
Is your pet neutered?*

YesNo
Has your pet had a blood transfusion in the past?*

YesNo
Is your pet up to date on all vaccines, and receiving regular flea/tick/heartworm/deworming preventative medications (if applicable to species)?*

YesNo
Has your pet been fed a commercially formulated food (i.e., not raw fed)?*

YesNo
Has your pet received treatment for a long-term chronic condition?*

YesNo
Does your pet have an agreeable temperament that allows for administration of mild sedation?*

YesNo
Would you consent to a small shaved area on the neck and gentle sedation for blood donation?*

YesNo
Please list all medications/supplements your pet receives at any time? (ex. occasional Metacam)?*
who, when, where, how, what
OPTIONAL: How did you discover our blood donation program?
who, when, where, how, what
Should be Empty:

Donor Screening