Application Form

HEROES FOR HEALTHY PETS^®

Application for
Heroes for Healthy Pets^®

Infectious Disease Business Certification

Get individual certification first

Before you can qualify for business certification, at least 50% of your staff must complete the individual certification process. Make sure each person has downloaded their individual certificate.

GET INDIVIDUAL CERTIFICATE

“*” indicates required fields

HEROES FOR HEALTHY PETS® PLEDGE

“Our business pledges to uphold the Heroes for Healthy Pets® program
standards and commitment to a disease-free, safe environment.”

YOUR BUSINESS INFORMATION

Business Name*

Business Street Address*

Business City*

Select State*

Business Zip Code*

Business Phone Number*

Email*

Website*

Individual Certification Checkbox*

At least 50% of facility staff is individually certified?*

Receive Emails Checkbox

I am interested in receiving emails from Merck Animal Health on products and/or programs and scientific information.

HEROES FOR HEALTHY PETS® PLEDGE

“Our business pledges to uphold the Heroes for Healthy Pets® program standards and commitment to a disease-free, safe environment.“

How many staff members are certified?*

Certified staff member*

Date of certification*

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Uphold pledge*

Certified Staff Member 2

Date of Certification 2

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Uphold Pledge 2

Certified Staff Member 3

Date of Certification 3

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Uphold Pledge 3

Certified Staff Member 4

Date of Certification 4

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Uphold Pledge 4

Certified Staff Member 5

Date of Certification 5

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Uphold Pledge 5

Certified Staff Member 6

Date of Certification 6

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Uphold Pledge 6

Certified Staff Member 7

Date of Certification 7

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Uphold Pledge 7

Certified Staff Member 8

Date of Certification 8

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Uphold Pledge 8

Certified Staff Member 9

Date of Certification 9

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Uphold Pledge 9

Certified Staff Member 10

Date of Certification 10

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Uphold Pledge 10

Certified Staff Member 11

Date of Certification 11

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Uphold Pledge 11

Certified Staff Member 12

Date of Certification 12

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Uphold Pledge 12

Certified Staff Member 13

Date of Certification 13

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Uphold Pledge 13

Certified Staff Member 14

Date of Certification 14

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Uphold Pledge 14

Certified Staff Member 15

Date of Certification 15

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Uphold Pledge 15

Certified Staff Member 16

Date of Certification 16

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Uphold Pledge 16

Certified Staff Member 17

Date of Certification 17

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Uphold Pledge 17

Certified Staff Member 18

Date of Certification 18

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Uphold Pledge 18

Certified Staff Member 19

Date of Certification 19

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Uphold Pledge 19

Certified Staff Member 20

Date of Certification 20

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Uphold Pledge 20

FACILITY ATTENDANCE*

How did your facility attend the Heroes for Healthy Pets® program (Understanding Infectious Disease & Infectious Disease Control)?*

Merck Animal Health representative led

Vetfolio

Other

Did your staff take the course online, or in person?**

Online

In person

Attendance – Other

Comments

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Application forHeroes for Healthy Pets®

Infectious Disease Business Certification

Application for
Heroes for Healthy Pets^®