Contact | Canine Rehab of New York

ONLINE REGISTRATION

To inquire about rehabilitation for your dog please use the online form below. We will contact you within 24 hours to discuss your pet’s condition and how we may be able to help. Please send previous medical records to info@caninerehabofny.com

First Name: *

Last Name: *

E-Mail: *

Spouse/Partner First Name:

Spouse/Partner Last Name:

First Name: *

Last Name: *

Relationship: *

Mobile Phone: *

Email *

Pet Name: *

Gender: *

Species: *

Breed: *

Neutered/Spayed: *

Color/Markings: *

What do you feed your pet and how much per day? *

Who is your Primary Veterinarian? *

Have you seen a Specialty Veterinarian? *

Why Are You Seeking Pet Rehabilitation? *

How did you hear about us?: *

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I agree to Terms & Conditions. By checking here I agree to pay all charges incurred at time services are rendered. *

Check here if you accept these terms.

Photo Consent: We love social media! Do we have your permission to share your pet(s) image and story on social media, our website and other forms of related media? Your name and personal information will never be shared. *

I authorize photo use.
I do not authorize photo use.

Numbers

Phone