WMPC HEALTH CLINIC, SUNDAY AUGUST 22, 2010

EYE APPOINTMENTS:  CANDY VAUGHAN 973 455-0841

BLOOD APPOINTMENTS:  ANGELA SPITALETTO, onlypoodles@yahoo.com

NAME: ____________________________________________PHONE: _________________________

ADDRESS:_________________________________________________________________________

EMAIL:____________________________________________________________________________

DOG NAME:____________________________________CALL NAME:_________________________

BREED:________________AGE:____________SEX_____SPAY/NEUTER________Weight________

If on medication. please list___________________________________________________

3-5 generation pedigree for OFA or CERF form necessary_____________________________

Stamped self-addressed envelope for SA biopsy/bloodwork necessary_____________________

TESTS FOR DR. JEAN DODDS ANALYSIS

1.  Thyroid 5 (T4, free T4, T3, free T3 and TgAA)        $80.00 _________

2.  Thyroid 4 (T4, free T4, T3, free T3 only)          $80.00 _________                   

3.  Profile 44 (T4 and free T4 only)              $55.00__________

      add T3AA, T4AA (AA’s)                  $30.00 ea________

4. Profile 7200 (minus CBC, deduct $6.) Chemistry, CBC and Thyroid 5    $120.00_________

5. Thyroid OFA Registry Panel (86135)             $120.00_________

    plus OFA Registry Form                                                                  $15.00 _________

6.  Profile D2 (minus CBC, deduct $6.)              $70.00__________

7.  Distemper & Parvo Vaccine Titers                $50.00__________

8   Rabies Titer                         $80.00__________

9.  Protatek tick-borne disease panel (Erlichia canis,

       Babesia canis, Lyme and RMSF)            $90.00__________

10. Heartworm Antigen                     $30.00__________

11. C6 Lyme antibody test                $70.00__________

BLOOD DRAW, SHIPPING & HANDLING                 $15.00___________

                         BLOOD SUB-TOTAL        ________________

ADDITIONAL

SEBACEOUS ADENITIS BIOPSY            $40.00_________

  Lab fee check to Ann Hargis, DVM, DACVP          $60.00_________

  OFA registration for SA - $7.50 clinic price, renewals free             $  7.50_________

Microchip, Home Again includes prepaid registration        $40.00_________

IDEXX Snap 4DX (Heartworm, Lyme, Erlichia, Anaplasma)$40.00_________

20/20 OptiGen Blood Draw               $15.00_________

Rabies Booster                        $20.00_________

DAPP Booster                 $20.00_________

Lepto4 Booster                        $20.00_________

                         TOTAL$______________

Make checks payable to WMPC, mail to WMPC c/o Angela Spitaletto, P.O. Box 125, McAfee, NJ  07428

REMINDER:PLEASE BRING YOUR 3-5 GENERATION PEDIGREE FOR OFA/CERF FORMS.

ALL TESTS MUST BE PREPAID BY 8/16/10 - NO REFUNDS