2018 Certification Clinic - April 13 - 14 - 15, 2018


Certification Clinic Registration Form


April 13 - 14 - 15, 2018


Graham Animal Hospital, 98A Trafalgar Road, HILLSBURGH, ON N0B1Z0

Please Do Not Call the Vet Clinic directly



Please complete all of the information in the form below. Information submitted in prior years was not carried forward from prior years. You will not be allowed to submit your form unless the required fields are completed. Required fields are marked with an asterisk (*) beside the field name. Enter n/a for fields that do not apply to your dog.

Be sure to check off your preferred day(s) in the boxes provided. Space is limited so appointments will be taken on a first come, first served basis until all available spaces are filled. Your appointment will be scheduled to match your selection as closely as possible; however, exact times cannot be guaranteed.

IMPORTANT: Please note that, for those ordering tests (DNA, prcd-PRA) on the Optigen website (www.optigen.com), the discount code for 2018 is GRCGT418. Registration is available until April 12. If you have questions about the Optigen tests ONLY, please contact www.optigen.com or genetest@optigen.com - Tel: 1-607-257-0301.

IMPORTANT: All procedures except Eye Exams will be offered on Friday, April 13, 2018.

IMPORTANT: THE CLOSING DATE FOR SUBMITTING AN APPLICATION FOR THE CLINIC IS APRIL 1, 2018.

IMPORTANT: Clients will be billed a $50 fee per dog for any ‘no-shows’ or cancellations with less than 48 hrs. notice.

PRICES: For information about prices for any of the screening tests, please download the current CLICK HERE FOR PROCEDURE PRICE SCHEDULE

OTHER INFORMATION:
Opthalmologist: Dr. Charlotte Keller
Cardiologist: Dr. Aaron Wey.

NOTE: SOME MAP PROGRAMS SHOW TRAFALGAR ROAD AS MAIN ST THROUGH HILLSBURGH.



Breed:*
Sex (M/F):*
Colour:*
Tattoo/Microchip:*
Friday: AM (no eyes)

PM (no eyes)


Saturday: AM

PM


Sunday: AM

PM


Choose Procedures: Heart-Auscultation

Heart-Doppler

Eyes-CERF

Blood-Thyroid

Blood-vWD

DNA (register with Optigen; bring form to clinic)

Hips-OFA

Hips-OFA Prelim

Elbows-OFA

Elbows-OFA Prelim

prcd-PRA (register with Optigen; bring form to clinic)

Patella - OFA

Other













Registered Name of Dog:*
CKC Registration#:*
AKC Registration#:*
Date of Birth (mm/dd/yyyy):*
Country of Birth:*
Breeder(s):*
Sire's Registered Name:*
Sire's Registration#:*
Dam's Registered Name:*
Dam's Registration#:*
Registered Owner(s):*
Owner's Street Address:*
Owner's City:*
Owner's Province:*
Owner's Postal Code:*
Agent's Name*:
Owner/Agent's Phone:*
Owner/Agent's Email Address:*


You will be contacted about 1 week prior to the clinic to inform you on the appointment time. Please bring your registration papers.


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