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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 South
6951 Highway 335 NE
P.O. Box 312
New Salisbury, IN 47161
812-366-4838
Fax 812-366-4931
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