Partner application form

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Location and contact information

Address*

Number of current staff

Practice manager*

Hours of operation

Facility details

How would you classify your facility?*
What animals are seen at your facility*
Is free parking available at your site?*
Is public transportation to your site available?*
Do you have an existing training program for new CVTs?*

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*

Surgery

Check all that apply*

Laboratory equipment

Check all that apply*

Anesthesia

Inhalation gases typically used*
Injectable agents typically used*
Monitoring equipment*

Procedures

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

Agreement and guidelines

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