2017 Certification Clinic - April 7 - 8 - 9, 2017


Certification Clinic Registration Form





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 2017 is GRCGT17. Registration is available from March 15 through April 9. If you have questions about the Optigen tests ONLY, please contact Bruce Russell at gowrielea@rogers.com

IMPORTANT: All procedures except Eye Exams will be offered on Friday, April 7, 2017.

IMPORTANT: THE CLOSING DATE FOR SUBMITTING AN APPLICATION FOR THE CLINIC IS APRIL 1, 2017.

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 PROCEDURE PRICE SCHEDULE

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

For further information, please contact Bruce Russell at gowrielea@rogers.com

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



Breed:*
Sex (M/F):*
Colour:*
Tattoo/Microchip:*
Friday: PM

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 (dd/mm/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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