262-350-7008
info@greatlakesvetderm.com

Home
About
Services
Forms
- New Client Form
- Consent Form
Payment
Refill Request
Contact





Home
About
Services
Forms
- New Client Form
- Consent Form
Payment
Refill Request
Contact

Holiday Hour Updates

The Holiday Season is quickly approaching! Before the season starts, we’d like to notify our clients of our adjusted holiday hours and encourage refill requests in advance. Please note, we kindly ask for 7 days advanced notice for medication refill requests and 14 days notice for immunotherapy serum refill requests. Our operational hours will be adjusted as follows:

Limited hours:

November 27 – 8am to 1pm

Closed:

Thanksgiving Day

Christmas Eve

Christmas Day

New Year’s Eve

New Year’s Day

Great Lakes Veterinary Dermatology would like to wish everyone and their pets a safe and happy holiday season!

New Client
Form

Get Started

New Client
Form

Get Started

New Client Form

Thank you for choosing us as your partner in providing exceptional care for your companion. To ensure we offer the best possible service tailored to your pet’s specific needs, we kindly request you to take a few moments to fill out this new client form thoroughly.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

What is your preferred method of contact for general communication? *

Email
Cell Phone
Home Phone
Work Phone

Please list any person who is authorized to make medical or financial decisions regarding this patient. *

How did you hear about us? *

Veterinary Referral
Referred by a Friend
Google
Yelp
Facebook
Instagram
Other

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Is your pet up to date on vaccines? *

Please provide date of the most recent rabies vaccine.

Has your veterinarian recommended antianxiety medication to facilitate veterinary examinations? *

Referring Veterinary Clinic *

Referring Veterinary Clinic Address *

Address Line 1

Address Line 2

City

State

Zip Code

Referring Veterinary Clinic Phone *

Referring Veterinary Clinic Email

If yes, please administer prior to your dermatology appointment as directed by your veterinarian.

Do you have additional pets? Please list *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a third pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fourth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fifth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

I hereby authorize the veterinarian to examine, prescribe or treat the above patient. I assume full responsibility for all charges incurred in the care of this animal. I also understand that these charges are to be paid in full at the time of release. Payments are expected when services are rendered. In order to provide the best care, we accept all major credit cards (MasterCard, Visa, Amex, & Discover), checks and cash. *

I have read the above terms and conditions and agree to adhere to this agreement.

Phone

Ready for a visit?

We feel honored to provide service to pets from all over the Midwest. We hope to see you and your pet soon.

Book Appointment - Coming soon

Questions?

Please contact us! We eagerly await your response.



Location

Located within Sendik’s Towne Centre
19035 W. Capitol Dr
Suite J-100
Brookfield, WI 53045



Contact Information

Phone: 262-350-7008
Email: info@greatlakesvetderm.com



Hours

Monday-Thursday: 8:00am – 5:00pm
Friday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Phone

We proudly serve the pets of southeastern Wisconsin & beyond.

Providing dermatology and allergy services to pets from all over the Midwest.

Holiday Hour Updates

New ClientForm

New Client Form

New Client Form

New Client
Form

New Client
Form