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

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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 Patient
Intake Form

Get Started

New Patient
Intake Form

Get Started

Patient Intake Form

Please complete the New Patient Intake Form below with all details. Your thorough information will help us provide the best care possible.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

Pet Information

Pet's Name *

Age or Date of Birth *

Breed *

Species *

Sex *

Male
Female
Neutered Male
Spayed Female

Current on vaccines? *

Please provide date of last rabies vaccine. *

Does your pet require antianxiety medication to facilitate veterinary examinations? *

If yes, please administer as directed by your veterinarian.

Current Weight *

What is the primary problem for today’s appointment? *

When did this problem first start? *

Please list your pet's current symptoms

List any medications previously and/or currently tried for this condition

What other pets are in the household? *

Do any other pets or people in the household have skin problems?

Other than skin and/or ear disease, does your pet have any diagnosed medical problems?

If yes, please list those diagnoses here.

Are there any other comments you would like us to know about your pet’s skin and/or ear disease?

Kindly upload any relevant medical reports or photos of your pet that may aid our veterinarians in providing the best care. Your pet's information is safe and will only be used for medical reference.

Click or drag a file to this area to upload.

Payment Information

ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED, AND DEPOSITS ARE REQUIRED ON ALL HOSPITALIZED PATIENTS. I will be paying by

Cash
Check
Credit Card (Visa, Mastercard, Discovery or American Express)

Comment

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.

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Location

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

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Contact Information

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

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Hours

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

Name *

First

Last

Email *

Phone

How can we help you? *

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 PatientIntake Form

New Patient Intake Form

Patient Intake Form

New Patient
Intake Form

New Patient
Intake Form