In order to be able to accept checks, we require the last four digits of your Social Security Number Last four digits of SSNPATIENT INFORMATIONName: Pet's name* Breed of Pet: Canine BreedsAffenpinscherAfghan HoundAiredale TerrierAkitaAlaskan HuskyAlaskan Klee KaiAlaskan MalamuteAmerican SpitzBasenjiBasset HoundBearded CollieBedlington TerrierBelgian MalinoisBelgian TervurenBernese MountainBichon FriseBloodhoundBlue HeelerBouvier Des FlandresBoxerBoykin SpanielBrazilian FilaBriardBrittany SpanielBrussels GriffonBull TerrierBulldog- EnglishBulldog- FrenchCairn TerrierCanaan DogCane CorsoCatahoulaCav King CharlesChes Bay RetrieverChihuahuaChinese CrestedChinookChow ChowClumber SpanielCockapooCocker SpanielCollieCollie- Smooth CoatCoonhoundCorgi- CardiganCorgi- PembrokeCoton De TulearCurly Coat RetrieverDaschund- MiniatureDaschund- StandardDalmationDoberman PinscherDogue De BordeauxDutch ShepherdEnglish SetterFox TerrierGerman ShepherdGolden RetrieverGrand Basset GriffonGreat DaneGreat PyreneesGreyhoundIrish SetterIrish WolfhoundItalian GreyhoundJack Russell TerrierJapanese ChinKeeshoundLabrador RetrieverLeonbergerLhasa ApsoMalteseMastiffMastiff- BullMastiff- EnglishMastiff- NeapolitanMastiff- TibetianMiniature PinscherMixed (over 100 pds)Mixed (51-100 pds)Mixed (31-50 pounds)Mixed (11-30 pounds)Mixed (0-10 pounds)Mountain CurrNewfoundlandNorwegian ElkhoundOld Eng SheepdogPapillonParson Russell TerrierPekingesePlott HoundPointerPomeranianPoodle- MiniaturePoodle- StandardPoodle- TeacupPugRat TerrierRhodesian RidgebackRottweilerSaint BernardSalukiSamoyedSchipperkeSchnauzer- GiantSchnauzer-MiniatureSchnauzer- StandardShar PeiSheltieShetland SheepdogShiba InuShih TzuSiberian HuskySilky TerrierSpitzVizslaWeimaranerWest Highland TerrierWheaten Terrier Feline BreedsAbyssinianAmerican CurlBalineseBengalBirmanBobtailBombayBurmeseCornish RexDevon RexDomestic LonghairDomestic Med HairDomestic ShorthairEgyptian MauHimalayanMaine CoonManxMunchkinNorwegian Forest CatOcicatPersianRagamuffinRagdollRussian BlueSavannahScottish FoldSiameseSnowshoeSphynxTokinese Color: Coat Color* Spayed Female Neutered Male Female Male Pet's Birthdate (or approximate): Pet's Birthday* Previous Veterinarian: Name of Previous Veterinarian All fees are due at time of service. We accept Cash, Checks, Visa, MasterCard, American Express, and Discover. Please note that appointments canceled with less than a 24 hour notice will incur a $70 cancellation fee.