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22320 Salamo Rd,
West Linn, OR 97068

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TELEMEDICINE REQUEST FORM

You can submit our Telemedicine Form in two ways:

1) Print and fill out our Telemedicine Form here. You must bring the form printed and filled out on your next visit.

Or

2) Fill out our form online:

TELEMEDICINE REQUEST FORM

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Client Name:*
For Today's visit, which of the following symptoms are present:*
Monthly Heartworm / deworming / flea preventive:
Appetite:
Any changes in food/treats?
Water Intake
Activity Level:
Any Seizures?

History

Have you noticed any changes to their normal behavior?
Do you need any medication refills?
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