To Whom It May Concern:
                                                                                                has applied to the Siamese Rescue Alliance 
to adopt a Siamese Cat. Because distance often precludes a home visit, we 
would like to obtain a reference to 
ensure we are making an appropriate placement. We would appreciate your time in
assisting us by filling out this reference form.

Name of Veterinarian:                                                                                                      

                  Address:                                                                                                      

                                                                                                                                     

                        City:                                                                                                      

                      State:                                              Phone:                                             

How long have you known this client:                                                                               

Would you consider him/her a responsible pet owner:                                                       

To the best of your knowledge, are his/her animals up-to-date with their shots:                   

Have they been tested for Feline Leukemia?                           For FIV?           

Results?                                                                                                     

Are there any reasons why you would NOT recommend placement of a Siamese with this client?

                                                                 

Any other comments:
                                                                                                                                  

May we telephone you if needed?                           

Signature: