Animal Dentistry and Oral Surgery Specialists, LLC

2409 Omro Road
Oshkosh, WI 54904-7713

(920)233-8409

www.mypetsdentist.com

You can expedite your check in at your appointment by submitting your patient's information online prior to your appointment. We look forward to working with you and providing the highest level of veterinary dental care to your pet.



New Client Information

Name & Email (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pet's vaccines current?
Do you have pet's medical records?
Name of Family Veterinary Practice

Veterinarian you wish to receive case report?
Yes
No


Would you like us to call you for your appointment?
Primary concerns that prompted your visit?

Special requests or conditions?

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Animal Dental Center-Milwaukee/Oshkosh and that charges are due and payable at the time of service. If I use Care Credit for delayed payment options, I will ensure I have alternate payment methods available in the event Care Credit does not cover the full cost incurred. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Animal Dental Center-Milwaukee/Oshkosh's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges. I also understand that the Animal Dental Center Milwaukee/Oshkosh has a teaching function. Dr. Kressin may take photos or radiographs (x-rays) when working with my pets. I agree to give him consent to use these photos and radiographs for teaching, presentations, scientific papers, informative communication, promotion or website usage. No compensation for use of these photos or radiographs is expected.
I have read this statement and -
I Agree
I Disagree



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