Animal Dental Specialists of Upstate New York

6867 East Genesee Street
Fayetteville, NY 13066

(315)445-5640

www.adsuny.com

After completing the form below, please submit vaccination certificates, any available laboratory results, dental radiographs, and/or any other previous medical history available to our office via email at contact@adsuny.com.  Thank you for your referral!

Referral Form

Referring Veterinarian: (required)
First Name (required)
Last Name (required)
Referring Hospital Address: (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Referring Hospital Phone: (required)
Phone TypePhone Number (required)
Referring Hospital E-Mail: :
Client's Name(s): (required)
First Name (required)
Last Name (required)
Client's Address: (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Client's Phone: (required)
Phone TypePhone Number (required)
Additional Client Phone (if available):
Phone TypePhone Number
E-Mail Address: :
Pet's Name: (required)

Species: (required)

canine
feline


Patient's Date of Birth: (required) :
Patient's Weight (in pounds): (required)

Patient's Breed: (required)

Patient's Color/Markings:

Gender: (required)

male, intact
female, intact
male, neutered
female, spayed


Use: (required)

pet
working
show


Vaccination Dates: (required)

History and Clinical Findings: (required)

Patient's Medications: (required)

Additional Comments:


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HOURS


Day Open Close
Monday *7:00am 6:00pm
Tuesday *7:00am 6:00pm
Wednesday *7:00am 6:00pm
Thursday *7:00am 6:00pm
Friday 7:00am 2:00pm
Saturday Closed Closed
Sunday Closed Closed

*Scheduled surgical procedure days.


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Contact

Phone:  315-445-5640

Email:  contact@adsuny.com


Fear Free Certified Professionals