Skip to content
New Patient Request Form
+1 (425) 742-0342
infolynnwood@adcmg.com
16429 7th Place West
Lynnwood, WA 98037
All fields marked with * are required and must be filled.
Please fill out the following form and one of our staff members will contact you to set up an appointment for your pet.
New Patient Information
First name
*
Last name
*
Street address
City
State
Postal code
Email
*
Home phone number
Mobile phone number
How did you learn about our clinic?
Internet
Phone book
Friend
Regular Vet
Other Vet
Website
Pet Information:
Pet Name
Species
Dog
Cat
Horse
Breed
Color
Age
Gender
Pet Medical Treatment
Please list the clinics where you have taken your pet for medical treatment in the last year
Type of food
What brand and flavor of food are you feeding your pet? (For example: Natural Balance Dry - Salmon and Potato)
Flea Treatment
If flea treatment is being used, what brand is it? (i.e. Frontline, Advantage, Program)
Type of shampoo
If your pet is bathed, what type of shampoo is used? If you take your pet to the groomer, if possible, call your groomer to find out what product they use.
What issue(s) if your pet experiencing that prompted you to request a consultation at Animal Dermatology Clinic - Lynnwood?
Message
Additional Notes
-1.png "website_banners (2)-1")
