MEDICAL BUSINESS LICENSING APPLICATION
I. APPLICANT INFORMATION
- 1.1 Title: Ms.
- 1.2 Full Name: Lauren Carlisle
1.3 Date of Birth: 07/26/1992
1.4 Phone Number: 444-7000
1.5 Residential Address: 3402 Magellan Ave, Floor 5, Room 7, Los Santos, San Andreas
1.6 ((GTAW Forum Name)): Boots
II. EDUCATION
- 2.1 Name of High School: Colorado State Online Academy
- 2.2 Year of graduation: 2010
- 2.3 Name of College/University (or N/A): Colorado State University
- 2.4 Year of graduation (or N/A): 2019
III. Practice Information
- 2.1 Business Name: Sunset Animal Clinic
- 2.2 Business Fictitious Name(s): Sunset Mobile Animal Clinic
- 2.3 Business Address: 5368 Bay City Avenue, Los Santos, San Andreas
- 2.4 Field of Activities: Veterinary Pet Care Services, General Veterinary Care, Surgical Care, Hospitalization, Ambulatory Services, Diagnostic Testing, rendering treatment and vaccines, providing veterinary medical advice.
- 2.5 Business Summary: Sunset Animal Clinic provides affordable, general and quality pet care services. To include basic examinations, general wellness checks, boosters and vaccines, fecal testing, heartworm testing, grooming, and pet bathing services. The clinic currently possesses two examination rooms for general veterinary care, and typically renders medications for animals in the form of injections. We possess both a diagnostic and surgical center for x-rays, ultrasounds, and surgical care. The clinic also possesses a modified Vapid Speedo Express van that was sent off to a veterinary equipment specialist company who installed various equipment - to include an examination table, lockable shelving and drawers to hold medical apparatus, and a deep metal basin for bathing. After installation, it was inspected by the proper authorities and is regulated and approved. I also possess my state veterinary license for the state of San Andreas as well as the state of Colorado, where I originally resided.
IV. SHAREHOLDERS
- Mark with where applicable.
3.1 Is the applicant in possession of the majority of shares (>50%) of the business?
Yes
No
3.1.1 If selected "No" in the previous question include reasoning (Within the State of San Andreas a Physician must be the 51%+ holder):
Not applicable.
3.2 List of Shareholders
Full Name Date of Birth Phone Number Number of Shares Lauren Carlisle 07/26/1992 444-7000 100
V. ADDITIONAL INFORMATION
- 4.1 Anything else you would like to add?
I have attached a copy of my Doctorate of Veterinary Medicine for your review. *There would be an attached official copy of a Doctorate Degree in Veterinary Medicine issued by the Colorado State University with Lauren Carlisle's name listed and accredited.* I have also attached my Veterinary licensure for the state of San Andreas and Colorado. *Two documents would be attached, which would display a copy of two licenses from each respective state with her license number and expiration information.* I also have my certification in exotic and large animal veterinary medicine. *Attached is the accredited referenced certifications.*
4.2 Any other employee's requiring licensing?
We have veterinary technicians that assist in general services, but do not render treatment. I do not believe licensing would be required. If any future Veterinarians are hired, I will update the licensing information.
