Referring a Veterinarian/Facility

Your Name: *

Your Email: *

Who are you referring?

• Veterinarian/Veterinary Hospital
• Rescue/Foster Organization
• Grooming
• Boarding
• Other

If Other:

Address and/or website: *

The referred has cared for (or has strong knowledge) in the following area(s): *

• Cerebellar Hypoplasia
• Seizures/Other Neurologic Conditions
• Mobility/Wheelchair/Amputee
• Hearing/Vision Loss
• Diabetic
• Congenital Defects/Deformities
• Other (please list below what exactly)

I understand by checking below that I do not hold "president" Bifford or his "campaign" liable or responsible for anything that may stem from contacting any of the listed facilities on their map. I understand that "president" Bifford is unaware of any of these facilities pricing, practices or protocols. Please ensure you do your own homework on any veterinary facility you decide to take your pet to or any organization you contact! *

• I Agree
• I Do Not Agree

Other:

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