Shadow Agreement Form

3 – 157 Ctr Edwardsville IL 62025
4 – 157 Ctr Edwardsville IL 62025
618.655.5313
info@heartlandveterinaryil.com

SHADOW AGREEMENT

Welcome to our shadowing program. We hope that you will find your time with us beneficial as you learn more about the veterinary industry.

You will be assigned a direct supervisor and will work with them or another assigned supervisor. You should remain with your assigned supervisor during the time on site.

Schedule
We will work with you to find a specific schedule that works with you as well as the practice. If you will arrive late or cannot make it for your scheduled shift, please let us know.

Appearance and dress code
While at Heartland it is important that all team members maintain a professional appearance while dressing appropriately. Our recommended dress code for shadows includes:

Scrubs or dress pants/t-shirt (no jeans, shorts or leggings)
Closed toe shoes

Activities and responsibilities
As a shadow, your main responsibility is to observe in a supervised manner. Some examples include:

Observing DVM or technician staff in a consultation or treatment room
Observing surgeries or other procedures
Ask questions! We recommend bringing a small notebook to write down questions or take notes throughout the day.

Shadows never

Give medications or injections
Dispense medication
Instruct clients on the care of their pet
Work with equipment without supervision
Take radiographs or assisting with procedures
Handle any controlled substances
Handle or touch animals, including restraining. Your supervisor will advise you on which animals can be touched.
Access computers or medical records unless under direct supervision

Emergencies
If an emergency should arise, please move aside and allow our veterinary team to perform the necessary medical attention. Although emergencies can be exciting, the best thing to do is to wait until after the pet has been stabilized, and ask questions of the team.

Confidentiality
While shadowing at Heartland, you may see or hear private information regarding a client and/or their pet. This information is to be handled with confidence and not shared with those outside the Heartland team. Discussing generalities of the day are fine, but specifics such as client or pet specific information should not be shared. Photos of animals should not be taken without client written consent.

Shadow Information

Full Name:

Contact Phone Number:

Contact Email Address:

Emergency Contact Name:

Emergency Contact Phone Number:

Date of Birth:

Desired dates for shadowing:

Available times for shadowing:

What would you like to most gain from your shadowing at Heartland Veterinary Hospital?

Shadow release:

I understand that my time at Heartland Veterinary Hospital is voluntary on my part. I am neither an employee, agent, not associated with Heartland Veterinary Hospital in any other capacity other than a temporary shadow. I hold Heartland Veterinary Hospital and its staff harmless and free from any and all claims that may arise as a result of my shadowing. I understand that Heartland’s workers compensation insurance will not cover shadows and must carry my own insurance policy that covers accidents or injuries.

Date of Signature:

Signature of Shadow:

Sign above

Signature of parent/guardian (required if minor under 18)

Sign above

Signature of Heartland employee:

Sign above

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Shadow Agreement Form

Shadow Information

How Are We Doing?

How Are We Doing?

Get In Touch