HQHVSN Surgical Techniques Application for Training

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Do you have a valid license to practice veterinary medicine in the State of Texas?*

Do you have liability insurance?*

Please upload a copy of your liability insurance.*

We are sorry, but you must have a valid license to practice veterinary medicine in the State of Texas and current liability insurance.

What is your license number?*

What Veterinary College did you attend?*

What year did you graduate?*

Who is your current employer?*

Approximately how many spay/neuter surgeries have you performed?*

When was the last time you were performing spay/neuters on a regular basis?*

Date

How many spay/neuter surgeries are you comfortable within a 6 hour day?*

On average, how long (minutes) does it take you to perform each type of procedure?*

	Male	Female
Cat
Small Dog
Medium Dog
Large Dog

List your preferred dates for training with us:*

What do you expect to gain during this training?*

Why are you wanting to attend this training?*

How did you hear about us?*

The cost of this training is $200 per day. Full paid scholarships are available in return for agreeing to volunteer with Texas Litter Control the same number of shifts as the number of training days.

Are you volunteering or paying for the training?*

Filling out this application does not guaranty accepance into the training program. Someone will be contacting you within 72 hours. Thank you for your interest!

Signature*

HQHVSN Surgical Techniques Application for Training - Intermediate to Advanced