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(604) 564-2214
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About
About VetDerm Clinic
Meet Our Team
Careers
Pet Owners
General Information
Cryotherapy
Phovia Therapy
Allergy Desensitization Therapy
Allergy Skin Testing
Canine Itch Scale
Feline Itch Scale
Ear Care for Pets
Laser Therapy for Pets
Forms
Preparing for Your First Consultation
Preparing for Your Follow-Up Consult
Veterinarians
General Information
Cryotherapy
Phovia Therapy
Referral Process
Allergen Specific Immunotherapy (ASIT)
Intradermal Allergy Testing (IDAT)
Video-otoscopy for Ear Care
Rush Immunotherapy
Fear Free Love
Pet Parents
Veterinarians
Blog & Articles
Location
Surrey
Coquitlam
Vancouver
Online
Telemedicine – Pet Owners
Teleconsultations – Veterinarians
Contact Us
Menu
About
About VetDerm Clinic
Meet Our Team
Careers
Pet Owners
General Information
Cryotherapy
Phovia Therapy
Allergy Desensitization Therapy
Allergy Skin Testing
Canine Itch Scale
Feline Itch Scale
Ear Care for Pets
Laser Therapy for Pets
Forms
Preparing for Your First Consultation
Preparing for Your Follow-Up Consult
Veterinarians
General Information
Cryotherapy
Phovia Therapy
Referral Process
Allergen Specific Immunotherapy (ASIT)
Intradermal Allergy Testing (IDAT)
Video-otoscopy for Ear Care
Rush Immunotherapy
Fear Free Love
Pet Parents
Veterinarians
Blog & Articles
Location
Surrey
Coquitlam
Vancouver
Online
Telemedicine – Pet Owners
Teleconsultations – Veterinarians
Contact Us
Pet Owner Initial Consultation Request
GENERAL INFORMATION
Client Full Name
Spouse/Partner Full Name
Alternate Guardian:
Primary Phone Number:
Secondary Phone Number:
Contact Email:
Address:
City
Postal Code:
Patient Information
Patient Name:
Date of Birth:
Sex:
Spayed/Neutered:
Species:
Canine
Feline
Other
Breed:
Spayed/Neutered:
Family Veterinary Hospital/Clinic:
May we contact this clinic for a copy of your pet's medical records?
Answer
No
Yes
Expectations for your visit/Reason for visit:
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Victoria and Vancouver Island
Vancouver and Lower Mainland
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by KIAI Agency