Training Wait List Form
Please fill out this form in entirety to ensure we can provide your pet with the best possible care.
Pet's Name
*
First Name
Last Name
Who would you like your pet to have as a provider?
Please Select
Dr. Rachael Kuhn-Siegel
Dr. Farmer-Doogan
Groomer
Your Name
*
First Name
Last Name
Email
example@example.com
What phone number can we use to reach you?
*
-
Area Code
Phone Number
Alternative Contact Name
*
First Name
Last Name
Alternative Contact Phone
*
-
Area Code
Phone Number
Which class are you wanting?
*
Is Your Pet Current On Vaccinations?
Yes
No
I Am Not Sure
My pet's vaccines were administered last by:
I Am Not Sure Where
Prairie Animal Hospital
Other
Authorizations
I verify that I am the owner (or authorized agent for the owner) of the above named pet and authorize treatment of my pet to be performed by Prairie Animal Hospital I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure as directed by the veterinarian.
*
Initial
I agree to be responsible for all charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. I understand no staff will be attending to my pet overnight (pets needing special care may be referred to a 24 hour hospital).
*
Initial
*
Submit Form
Should be Empty: