Lee K. Spyridakis, DVM, Dipl. ACVIM / Peter L. Wadsworth, VMD
Nick Cassotis, DVM / Kristen L. Rennie, DVM
96 Durham Rd. Dover, NH 03820
Phone: 603.742.6438    Fax: 603.742.4037
Email:

Please Check Which Department Needed: Surgery  Internal Medicine  Ophthalmology  Physical Rehab
Owner:	Veterinarian:
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DOB:	Sex:   M   MN   F   FS
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Please Label Owner's Name & Hospital
X-Rays Sent: Yes  No	Number of Films Sent:
Bloodwork Sent: Yes  No
Histopathology / Cytology Sent: Yes  No