Town & Country Animal Clinic

Forms

Save some time at your first visit by printing & filling out your paperwork before arriving.

This form is for all new clients that will be coming here for regular visits with Dr. Leach or Dr. Vaillancourt:

New Client Form

This form is for all new *REFERRAL* clients that will be coming to see Dr. Hansen:

Animal Dental Center of WNY New Client Form

Along with the form above all new *REFERRAL* clients for Dr. Hansen will need to have their regular veterinarian fill out the following form and fax it to us:

Animal Dental Center of WNY Referring Veterinarian Form

In addition, the following forms are for our Cone-beam CT machine.  If your vet has referred you to Dr. Hansen for a CT only, please complete the new client form below.  Your vet will also need to fill out the CT specific referral form below.  You *MUST* have bloodwork preformed by your vet ahead of time & faxed along with the referral form.

Cone-beam CT New Client Form

Cone-beam CT Referring Veterinarian Form