Veterinarian Reference

The veterinarian who fills out this form will not be held liable for opinions expressed within this form. If you currently do not have a veterinarian, you may ask a veterinarian who will be working on your equine(s) to fill out the form stating that he or she is willing to work on your equine(s). The purpose of this form is so that IHR will know that you have a veterinarian available whenever your adopted or fostered equine needs veterinary care.
Your veterinary reference may not be a immediate family member and it also may not be the same person who fills out any other reference form(s) for you.

To be completed by adopter/foster applicant:

Name: _____________________________________________________

Address: ___________________________________________________

Phone:  ____________________________________________________

To be completed by veterinarian:

Name: _____________________________________________________

Address: ___________________________________________________

Phone:  ____________________________________________________

How long have you been treating the applicant’s animals?____________

If you have not previously worked with the applicant's animals, after speaking with the applicant, would you be willing to work with any equine he/she may adopt or foster from Indiana Horse Rescue?

Does the applicant keep his/her animals current on their vaccinations and other health care?

Describe your impression of the care and condition of the animals the applicant currently owns:

Do you think the applicant would make a good foster or adoptive home for an equine from Indiana Horse Rescue?

Why or why not?


Signature 

Date

Thank you for taking the time to complete this form!

Please return to:

Indiana Horse Rescue
916 S Prairie Ave
Frankfort, IN 46041
(765) 659-5209
Fax (206) 338-5604