BLOOD DONATION QUESTIONNAIRE

1. Species of recipient animal: Dog/ cat/ other

2. Age and health problem of recipient.

3. How much blood is needed?

4. Criteria of donor animal.

5. Location -- area and hospital name.

6. Whether the blood can be picked up from the donor's location -- this avoids transporting the donor all over town.

7. If the answer to #6 is no: If the donor dog is friendly, is the pet parent willing to transport the donor animal to the hospital, draw the blood, and send him / her back? Finally, the name and contact of the pet parent or coordinator.