Clinic Sign Up

The name Heartlight Dobermans comes from my commitment to promote cardiac testing, early detection, raise awareness and support research to find answers to save our breed from arrhythmia and dilated cardiomyopathy.

ALL CLINICS ARE PREPAID

unless otherwise stated

Make checks payable to MVC and mail to
Sue Krom
8 Cranberry Dr.
Holyoke, MA 01040

to pay by MasterCard/Visa click here

DOGS MUST BE PRE-REGISTERED in order to receive your report on the day of the clinic
Please fill out all information below, if there is no answer, please put in N/A.

Name and Date of Clinic:
Type of Appointment:
Owners Name:
Address:
City:	State:	Zip Code:
Email	Phone / Cell Number:

What Breed is Your Dog:
Dogs Registered Name:		Dogs/Cats Call Name:
Dog/Cat Sex:		Intact / Spayed / Neutered:
Dogs AKC #:
Dog/Cat Color, Weight and Age:

Veterinarian Name:
Practice Name:
Address:
City:	State:	Zip Code:
Phone:	Fax:

Is your dog/cat taking any medications currently? If so, please list them along with the frequency and dosage:

Has your dog/cat had an echocardiogram performed in the past? If so, was it performed by Dr. Morris? (If performed by another cardiologist please bring a copy of the report with you)

Has your dog had a 24 hour holter monitor performed in the past? If yes, please list dates and if performed by Dr. Morris, please bring a copy of the report(s) to the visit.

Additional Comments (i.e. request morning or afternoon appt./ ring conflict)