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ACVO NATIONAL SERVICE ANIMAL EYE EXAM
May 1 - 31, 2019
Service Animal Registration Form
   Please thank your veterinary ophthalmologist for donating ALL of their time,
staff and facility to participate in this event. We could not do it without them! 
      

To register your Service or Working Animal for the event, complete and submit this form no later than April 30th. After registering your animal, you will receive a confirmation email which will contain your confirmation number, program instructions and a list of participating clinics. It is your responsibility to make the appointment with the clinic of your choosing at that time. Appointments are provided by the clinic based on their own availability and will be granted on a first-come, first-served basis. We encourage early registration and those registering later in the month may find that appointment slots are no longer available. If you find that your first pick location doesn’t have an appointment that works for you, you may consider an alternative location. Veterinary ophthalmologists are volunteering their time and staff for this event, they are not required to make appointments beyond their availability.

Proof of registration for this event does not necessarily mean your animal qualified for the program. Please check qualifications carefully before registering.

If you are visually impaired and need assistance completing this form, please call the ACVO office at 208-466-7624, Monday – Friday between the hours of 9am-4pm MST. Please do not call if you are visually able to register, we have very limited staff available for telephone calls.

*This is a eye health screening exam only.  

  
SERVICE ANIMAL INFORMATION - Please submit one form per Service Animal.
Required items **

Service or Working Animal's name**:

Breed**:
Years of service**:
Type of working animal **:
This Service Animal was examined at the 2018 Service Animal event (will not exclude the animal from receiving an exam in 2019).
   
HANDLER/OWNER INFORMATION
Handler/Owner's name**:
Street address**:  
City**:    State**: Postal code**:
Telephone: (Optional, for doctor use only.)
Email**: (Required. Will be used for event emails and confirmation number.)
   
REFERRAL INFORMATION
Where/how did you learn about the event? **:
General practice veterinarian name or clinic, if known:

Please allow 30 seconds for registration to process. Select the submit button to finalize your registration. If you need to change any data contact us at servicedog@ACVO.org. Allow 24 hours for response.

SUCCESSFUL REGISTRATION DOES NOT SECURE AN APPOINTMENT. 

PLEASE CALL A VETERINARY OPHTHALMOLOGIST DIRECTLY TO SCHEDULE YOUR APPOINTMENT, THE LIST WILL BE PROVIDED IN YOUR CONFIRMATION EMAIL.