Application Organization Name* Clinic Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Contact Name(Person who will coordinate training) First Last Contact Title Contact Email* Contact Phone*Describe your veterinary programs*spay/neuter clinicfull-service veterinary clinicnot open yetDescribe your organization*(please check all that apply) for-profit general veterinary clinic animal shelter with general veterinary clinic non-profit stand alone general veterinary clinic for-profit spay/neuter clinic animal shelter with spay/neuter clinic non-profit stand alone spay/neuter clinic other Please specify organization type* Payment options your organization offers* Select All Care Credit Scratchpay VetBilling Payment Plans VetBilling Pre-Savings Plans Medical Fund Crowd Funding (i.e. Waggle) Referrals to non profit charity grants (e.g. Brown Dog, Frankies Fund) Other Please describe other payment options you provide* What is your current net positive revenue for veterinary services?*(e.g. $20,000 annually, negative profit) How many patient do you see a year?* Services you provide* Select All wellness sick care routine surgeries advanced surgeries emergencies euthanasia other Please describe other serivces* Why are you interested in this mentorship?*What would you like to learn from this mentorship program?* Select All Patient-centered incremental care focused on a problem-solving approach to achieve the best possible outcomes for the family in an effort to preserve the human-animal bond in the context of limited resources Creating operating efficiencies with scheduling, staffing and inventory Continually analyzing expenses and revenue and making modifications to budget line items in real time and setting goals Offering multiple financial assistance options to ensure a safety net to provide care. Establish collaborative efforts with human social services and non-profits to keep pets with their families Integrating social workers into your practice Help opening a clinic from the beginning (including equipment, pricing, SOPS, floorplan review and getting open) Describe the type of training you are interested in*(virtual, sending a team to Toledo or Asheville, having your team come to our clinic)CAPTCHANameThis field is for validation purposes and should be left unchanged.