<p align="right"><font size="5" face="Verdana"><strong><font size="6">Animal Medical Center</font><br />
</strong><font size="4" face="Arial"><strong>(304) 292-0126</strong>&nbsp;<em> Your Pet's Second Best Friend</em></font></font></p>

Animal Medical Center
(304) 292-0126  Your Pet's Second Best Friend

shimshimshim
none
shim
shim
shim

Next Step Enrollment

Please complete the form below to enroll your dog in a Next Step Obedience Class. Please feel free to call or email us if you have any questions before (or after!) enrollment. After we receive your enrollment, we will contact you to confirm your registration and to schedule a consultation with one of our veterinarians and/or Lindsay before classes begin.

Form - Next Step Enrollment Form

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Phone (required)
Phone TypePhone Number (required)
Phone
Phone TypePhone Number
E-Mail Address (required) :
Dog's Name (required)

Dog's Age Today (in months) or Birth Date (required)

Breed (required)

Color (required)

Choose your class session (required)
September 13th - Ocotber 18th


Medical History
Where has your dog received his veterinary care? (required)
AMC. You should have all of my dog's current medical records.
AMC and another veterinarian. I will fax, mail or drop off records of any care received elsewhere so that you can review the record before class begins. *Please note the name & number of your veterinarian in the Additional Notes section below.
Another veterinarian has provided my dog's medical care. I will fax, mail or drop off a copy of his medical records before class begins. *Please note the name & number of your veterinarian in the Additional Notes section below.
My dog hasn't seen a veterinarian yet. Please contact me to schedule an appointment.
My dog hasn't seen a veterinarian yet. I will arrange for veterinary care.


Vaccination Status (required)
My dog is current on Rabies, DAPP and Kennel Cough (Bordetella). These vaccines were received at AMC or another veterinarian (or will have done so before classes begin).
My dog needs to complete or update his vaccinations before classes and will have them completed before the first class.
My dog still needs vaccines. Please contact me to schedule an appointment.
I am not sure if my dog has everything he or she needs. Please contact me to help me figure out if my dog needs further vaccines and to schedule needed services if needed.


Intestinal Parasite Control (required)
My dog has received deworming medication prescribed by a veterinarian within the past 60 days.
My dog has had a "negative" fecal exam within the past 60 days.
My dog is taking monthly heartworm preventative (Interceptor, Sentinel, Heartgard or Revolution).
I don't know my dog's fecal testing or deworming status. Please contact me to discuss intestinal parasite control and to arrange needed care.


Health Concerns (required)
My dog has not had any recent illness and is currently healthy. My dog does not have diarrhea or have weepy eyes, nose, sneezing or coughing or any rash or other signs of illness. My dog is free of fleas, ticks and earmites.
My dog has some current medical issues. Please review his/her medical record and let me know if he or she is OK to participate in class.
I don't know if my dog is healthy enough to participate. Please contact me to discuss my concerns.


Behavior History (required)
My dog is safe around people and pets. He has not bitten or attempted to bite anyone or any pet nor shown any severe signs of fear when exposed to new people or animals.
My dog has shown some mild signs of fear or aggressive tendencies but I feel he is safe for this class. (Megan will discuss this with you before the first class.)
My dog has had some significant fear or aggression issues but he has made progress and I feel he is ready for and safe for the class. (Megan will discuss this with you before the first class.)


Comments or Instructions


The verification code below ensures the form is not submitted by a computer
Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.


shim