NAH WIN Form

WINS Submission Form

We want to share the good that is happening in our hospitals with the community! When a feel-good story happens in our hospitals that you think is worth sharing, let Marketing know through this form.

1. Pet's Name

2. Pet's Age

3. Pet's Species:

Canine

Feline

Other:

4. Pet's Breed:

5. Pet's Sex:

Male

Female

Unknown

6. Pet was seen for:

(Symptoms or Problems)

7. Pet was diagnosed with:

(Condition or Injury)

8. All NAH services performed that helped with diagnosis:

Exam/consultation

Diagnostics

Both

Other:

9. Overseeing DVM(s)/Techs of this case:

11. Pet was recommended for:

(Treatment/Surgery/Other)

12. (OPTIONAL) Client/Pet Owner Name:

If they would like to be tagged or included in the post

Title

13. Based on last contact with owner, this pet is (check all that apply):

Eating again

Back to their old self again

Feeling so much better

Recovering and on the mend

Other:

14. DATE OF OUR LAST CONTACT WITH OWNER ABOUT THESE SPECIFIC UPDATES:

YYYY

15. Any other important notes on this case?

16. This owner has given permission for us to post on social media via:

We must have this before submitting this WINS form.

Permission given via online New Client Form

Permission given via the New Client Paper Form filled out.

Permission given verbally during or after the visit

17. Did the owner request to review the photo or post before it is published?

Yes

18. (OPTIONAL) If there is ALREADY a photo to go with this post in GroupMe, please include the date of posting. Or, skip this question and upload the photo below.

Pet Photo Upload:

Delete all uploads

Choose files or drag here

Date

2025

If there is a delay between this form, and a potential post, Marketing will not post before confirming that the pet is still doing well.

Staff Legible Signature:

Please don't close window until you see the SUCCESS message.