This form must be used if you are a veterinarian seeking to satisfy a portion of your continuing education requirements by providing free spaying and/or neutering services. For more information about this option, see Continuing Education. If you are not claiming the provision of free spaying and/or neutering services for continuing education credit, you do not need to fill out this form.
This form does not need to be submitted to the Department but it must be retained, along with any documentation attached to it, for a minimum of 6 years from the date of the provision of the services claimed on it. Once completed, it is recommended that you keep this form at your practice location. You are required to provide it, along with any attached documentation, to the New York State Education Department upon request.
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