Lehigh Valley Veterinary Dermatology

4580 Crackersport Rd
Allentown, PA 18104

(610)391-1200

lehighvetderm.com

New Client Check In

We are currently accepting new clients/patients.  If you would like to make an appointment, please submit the below form and someone from our office will contact you to schedule.   There is currently a long wait (>6 months) for new patients.  We do have an active cancellation list and are typically able to get patients in sooner.  You can also visit www.acvd.org to find other board certified veterinary dermatologists.   

Thank you for your interest in our practice.

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 TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Pet's Name (required)

Date of Birth

Type of Pet (required) :
Breed:

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are your pets vaccines current?
Do you have a copy of your pets medical records?
Name of Regular Veterinarian (include name of doctor and hospital)

Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?


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