Vet Hospital Application Roster

2. <strong>Pierce County Auditor's Office Animal Services</strong>.<br> 2401 S. 35th St. Room 200 <br> Tacoma, WA 98409<br> (253) 798-7427

   Pierce County Auditor's Office Animal Services.
   2401 S. 35th St. Room 200
   Tacoma, WA 98409
   (253) 798-7427

3. 

7. Clinic Name*

9. Clinic Address*

10. City*

11. Zip*

13. Phone*

14. Email*

15. Fax

17. Clinic Hours*

21. Medical Director*

22. Hospital Administration/Manager*

24. Number of Veterinarians on Staff*

25. Number of Vet Technicians on Staff*

29. What Services are Offered*

31. Capacity for Dogs*

32. Capacity for Cats*

34. Do you see or handle any other animals besides dogs and cats?*

    1. Yes
    2. No

35. Do you have policies in place for aggressive or fractious animals?*

    1. Yes
    2. No

37. What other animals will you see?*

38. Please Describe*

40. If medical attention is needed for an animal, can you hold the animal over a weekend to monitor the animal until a vet at the Humane Society is available to take over care?

    1. Yes
    2. No

44. Electronic Signature*

    Please type your first and last name

45. Date*
    Date

46. Terms of Acceptance*

    1. I understand that checking this box constitutes a legal signature. I certify under penalty of perjury, under the laws of the State of Washington, that the foregoing information is true and correct (RC

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48. 1. Receive an email copy of this form.
49. Email address

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50. Submit

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