OWNER INFO
Name___________________________________________Date____________________
Address________________________________________________________________
________________________________________ZIP Code_______________________
Phone(s)_______________________________________
Email__________________________________________
PET INFO
Name____________________________ Breed _________________________
Color __________________________ Sex… M F Neutered … Y N
Age or DOB ___________________ Weight __________________

CIRCLE THE SERVICES YOU WISH PERFORMED
Spay / Neuter under 40 lbs $ 225 ………Exam $45
Spay / Neuter over 40 lbs $ 325 ……… Rabies $20
……… DHPP $30 …………Influenza  $40
Dental Cleaning $295 ………….. Bordetella $30
Microchip $50 ………….. Lyme $30
Heartworm Test $30 ……… Fecal Parasite Test $30
Ear Smear $30 ……… Anal Gland Expression $25
Deworming $25 + ( depends on weight ) …………..Nail Trim $15

PRODUCTS – DO YOU NEED REFILLS ?
Heartgard Plus ……. Trifexis ……. Seresto Collar ( flea and tick collar)
Advantage Multi ……. Comfortis ……. Preventic Collar ( tick collar )
Nexgard ……. Activyl