Pet owners registration form

Email: info@vtbank.org
Tel: +44 (0)1691 778769
Fax: +44 (0)5603 411520

Submitted by admin on Thu, 01/27/2011 - 22:19

About you

Name: *

Email: *

Contact number: *

Town/City:

Street address:

Post code: *

Your pet

Pet's name: *

Species (cat/dog):

Breed:

Pet's date of birth:

Vet practice

Practice name: *

Street address: *

Town/city:

Post code: *

Please confirm you have read and agreed the terms and conditions of pet donor registration

Owner confirmation: *

I can confirm that I am the owner of the above animal, or have the authority to make this decision, and I am not aware that anyone objects to this.

Please confirm you consent to us contacting your veterinary surgeon to inform them of your pet’s registration as a donor

News Updates:

I would like to receive information from Veterinary Tissue Bank about tissue donation and how this has helped other pets

If you wish to speak to a representative from Veterinary Tissue Bank regarding tissue donation, please call us on 01691 778769, or e.mail us on info@vtbank.org.

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