ADC General Contact Form
I am a:
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Pet Owner
Existing Client
Veterinary Professional / Hospital
How Can We Help?
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Please Select A Topic
I'd like to schedule an appointment for my pet
I'd like to speak to someone about dental treatment
I have a medical question about Dentistry / Oral Surgery
Other (Please Complete Comments section below)
How Can We Help?
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Please Select A Topic
I'd like to schedule an appointment or recheck
I have a question about medication my pet has been prescribed
I have a technical or billing question about my account
Other (Please Complete Comments section below)
How Can We Help?
*
Please Select A Topic
I have a record request or question about a referral patient
I'm interested in CE programs / Residency opportunities
I'd like to schedule a clinical shadow day for my practice
I'd like a case consult or image review with a specialist
Other (Please Complete Comments section below)
It looks like you would like to schedule an appointment or recheck for your pet. If so, would you like to be redirected to our patient appointment form?
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YES, please take me there now
NO, submit my request to the general mailbox
Contact Information
Your Name
*
Ms.
Mr.
Mrs.
Dr.
Title
First Name
Last Name
Clinic / Hospital Name
*
Please enter the name of the Hospital / Clinic you are inquiring on behalf of
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Question / Comments
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Case Image Upload
Browse Files
Drag and drop files here
Choose a file
Attach images (up to 10mb). For multiple files you can also email the files to XRAY @ animaldentalcenter.com
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of
Image Uploaded?
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