Canine Blood Donor Program Screening Questionnaire

Thank you for your interest in our Canine Blood Donor Program. Please answer the questions below and click the submit button when finished. We will be in touch shortly after reviewing your questionnaire for eligibility.

"*" indicates required fields

Owner's Name*
Owner's Email*
Owner's Address*
MM slash DD slash YYYY
Disclaimer: Your dog must be at least 40 pounds to participate in this program.
Disclaimer: Your dog must be neutered/spayed to participate in this program.
Does your dog have a calm and friendly temperament?*
Are you willing to drop your dog off on a regular basis for a half (1/2) day, six (6) times per year for a blood donation?*
Will you be in the Gainesville area for at least the next two (2) years?*
Was your dog rescued or rehomed?*
Is shaving the neck to obtain blood acceptable to you?*
Has your dog been pregnant?*
Disclaimer: If your dog has been pregnant or is currently pregnant, they are eligible to participate in this program.
Has your dog been bred (male or female)?*
Does your dog have a spleen?*
Has your dog ever been diagnosed with any bloodborne pathogens (includes Erhlichiosis, Rocky Mountain Spotted Fever, Babesiosis, or Lyme disease)?*
Has your dog ever received a blood transfusion?*
Is your dog on heartworm prevention all year?*
Has your dog had heartworms or has been treated for heartworms within the past three (3) years?*
Is your dog on a preventive for fleas and ticks?*
Is your dog on any medication for a health problem (includes antibiotics, aspirin, prednisone, carprofen)?*

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