New Client

Animal Dentistry and Oral Surgery Specialists LLC

Caring: Cat dentist-Dog dentist Vet dental and oral surgery services

Dale Kressin DVM, FAVD, Dipl. AVDC & Steve Honzelka DVM, Resident 888-598-6684

Oshkosh Milwaukee Waukesha Minneapolis and St Paul Metropolitan areas

This website was named by a client. She said you are my pet's dentist.
Dr. Kressin liked the name so we became my pets dentist dot com. We intend to make the site a dental and oral surgery information resource. We will update the site based on client and family veterinarian's requests. If you need specific information not on this site go here. If you would like to see additional information on this site feel free to comment to Dale@vin.com.

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form. This form may also be faxed to 920-233-1956.

Thank you for your cooperation in letting us assist you.

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Form - New Client

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 Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone 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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