Canine Blood Donor Screening Questionnaire

1. Welcome

7% of survey complete.

Thank you for your interest in the CARE Center Animal Blood Bank! The initial portion of our screening process involves finding out about your dog and it's lifestyle. Please answer the following questions to help us determine your dog's eligibility as a blood donor.

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* 1. Please let us know how to reach you with the status of your dog's eligibility for the canine blood donor team:

Name: *

Address: *

Address 2:

City/Town:

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. Pet's name

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* 3. Breed

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* 4. Sex

female

male

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* 5. Does your dog weigh over 50 lbs?

yes

Canine Blood Donor Screening Questionnaire

1. Welcome

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* 1. Please let us know how to reach you with the status of your dog's eligibility for the canine blood donor team:

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* 2. Pet's name

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* 3. Breed

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* 4. Sex

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* 5. Does your dog weigh over 50 lbs?

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* 6. Primary Veterinary Clinic Name

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* 7. Primary Veterinarian Name

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* 8. Where did you hear about the Blood Bank?