Mass / Legion Chart:
Enter a red dot/ circle on the chart where your pet's mass(es)/ legion(s) are located
Pet / Client:
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Pet Name
Owner First Name
Owner Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
Select Species - To continue to next step
*
Canine (Dog)
Feline (Cat)
Draw on Image Below
CLICK BLACK BOX TO CHANGE INK COLOR TO RED, THEN DOT OR CIRCLE LOCATION WHERE MASS(ES) IS/ARE TO BE REOMOVED / NEEDLE ASPIRATED.
CANINE - DOG: V: is Ventral/Front and D: is Dorsal/Back
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FELINE - CAT: V: is Ventral/Front and D: is Dorsal/Back
*
Enter Total Number of Masses/Legions/Skin Tags
*
Do not enter duplicate marks for the same mass/legion
Comments, Concerns, Questions:
Signature
*
Submit
DateTime
Should be Empty: