Report a Seizure Form

1
Owner's Information* This field is required.
First Name
Last Name
Email
Phone Number
Pet's Name
2
When did the seizure occur?* This field is required.
3
How long did it last?* This field is required.
4
How long after the seizure before your pet returned to normal?* This field is required.
5
Were any rescue medications used?* This field is required.
6
Other notes / Comments
7
Which neurologist does your pet see?
Please Select
Please Select
Dr. Levitin
Dr. Crook
Dr. Fefer
Dr. Flores
Neither of the above
8
This form is for current patients only. If your pet is experiencing a seizure and needs immediate medical care, please call us at 862-404-0991 or come right in. There is no appointment necessary to receive emergency care. If you would like to schedule an appointment with a neurologist, please complete this form.
9
Please verify that you are human* This field is required.
Should be Empty: