New Client Registration – Dodgeville Veterinary Services

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Mobile Phone Number
Email*
Co-Owner Name & Contact Information
Name*
First Last
Phone Number*
How did you find out about our clinic?
Select One*
If other, please specify
If personal referral, is there someone we can thank?
Please use this are to give us any other relevant information about your self or your family
Pet Information
Pet Name*
Select One*
Sex*
Breed*
Color*
Date of Birth or Approximate Age*
Special Identification (tattoo, microchip, etc.)*
What is the Reason for this Visit or Submission of this Form?*
Appointment
Appt Date & Time 1st Choice*
Appt Date & Time 2nd Choice
Appt Date & Time 3rd Choice
Comments

We Are AAHA Accredited

Dodgeville Veterinary Service

105 County Road YZ
Dodgeville, Wisconsin 53533

Office Hours

Monday 8:00am – 6:00pm
Tuesday 8:00am – 5:30pm
Wednesday 8:00am – 6:00pm
Thursday 8:00am – 5:30pm
Friday 8:00am – 5:30pm
Saturday- Closed
Sunday — Closed

Where tails wag, cats purr and owners smile

Client Registration

Co-Owner Name & Contact Information

How did you find out about our clinic?

Pet Information

Appointment

We Are AAHA Accredited

Dodgeville Veterinary Service

Office Hours