Partner application form

Veterinary Technology

"*" indicates required fields

Location and contact information

Organization*

Website*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Number of current staff

Number of veterinarians*

Number of CVTs*

Number of assistants and other staff*

Practice manager*

Yes

Hours of operation

Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Saturday*

Sunday*

Emergency hours*

Facility details

How would you classify your facility?*

Companion practice

Food animal practice

Research

Emergency

Mixed animal practice

Equine practice

Shelter

Referral, specialty, or other

What animals are seen at your facility*

Dogs

Cats

Rodents

Cattle

Horses

Birds

Reptiles

Swine

Sheep

Goats

Other

Referral, specialty, or other*

Other (please specify)*

Is free parking available at your site?*

Yes

Is public transportation to your site available?*

Yes

Who will be PCC's primary contact for your facility?*

Who will be supervising the student(s)?*

Do you have an existing training program for new CVTs?*

Yes

Please describe in as much detail as possible what the Student Veterinary Technician��s learning experience at your site will be like*

Diagnostic imaging

The use of personal protective equipment such as lead shields, thyroid shields, and lead-lined gloves is required. PCC provides student dosimetry badges.

Check all that apply*

Radiography

Digital radiography

Dental radiography

Digital dental radiography

Automatic processor

Ultrasonography

Endoscopy

Other

Other (please specify)*

Surgery

Check all that apply*

Laser surgery

AHAA Certified

Steam autoclave

Gas sterilization

Ultrasonic dental scaler

Dental unit

Other

Other (please specify)*

Please describe surgeries typically performed at this facility*

Laboratory equipment

Check all that apply*

Blood gas analyzer

Blood chemistry

Microscopy

Gram stain

Cytology

Centrifuge

Tonometry

CBC analyzer

Other

Other (please specify)*

What percent of lab work is typically sent to a commercial laboratory vs. being performed in-house?*

Anesthesia

Inhalation gases typically used*

Nitrous oxide

Sevoflurane

Isoflurane

Halothane

Other

Other (please speficy)*

Injectable agents typically used*

Propofol

Ketamine/Valium

Domitor/Antisedan

Xylazine/Yohimbine

Opioids

Barbiturates

Other

Other (please specify)*

Monitoring equipment*

Pulse oximeter

ECG

Blood pressure monitor

IV fluid pump

Ventilator

Other

Other (please specify)*

Procedures

At your facility, what procedures do technicians typically do?*

Admit patients

Make appointments

Client education

Examine patients

Discharge patients

Prep for surgery

Administer anesthetic

Cytology

Place IV catheters

Monitor anesthesia

U/A

Prepare prescriptions

Blood chemistry

Fecal analysis

Intubate surgical cases

Perform dental cleaning

Draw blood

Obtain other biological samples

Administer injectable medication

Take radiographs

Restrain animals

Other

Other (please specify)*

Please describe other technician responsibilities*

Agreement and guidelines

Captcha

This form is protected by reCAPTCHA. The Google Privacy Policy and Terms of Service apply.

Name

This field is for validation purposes and should be left unchanged.