Veterinary Dermatology Center
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New Patient Questionnaire

Please wait 24 hours to call the office at 407-629-0044 ext. 2 if you would like to verify that we have received your information.
  • Welcome!

    Please fill out our questionnaire and look for the confirmation at the end to ensure that you have submitted successfully. We recommend using a computer, as phones and tablets often result in an unsuccessful submission. A staff member will contact you within 48 business hours to schedule your pet for a new patient appointment.
  • Format: mm/dd/yyyy
  • Patient's Information

    Species
  • Referral Information

  • *If you were not referred to us please include your pet's regular veterinarian information. If you're not sure, please write that in the designated field.
  • Patient History

  • Heartworm and Flea Prevention

  • How did you hear about us?

  • The Veterinary Dermatology Center accepts cash, checks, major credit cards, and CareCredit. Payment is due in full at the time services are rendered. If you have pet insurance, we are happy to provide you with the necessary documentation to file a claim for reimbursement. A credit card number is required at the time of booking to hold all new patient appointments. Cancellations that are not made 48 hours in advance will be charged a $100 fee. To finish submitting this form, please check the box below to confirm you have read our payment policy.

Maitland Office (Main Office)

9901 N. Orlando Ave. (Hwy. 17-92)
Maitland FL 32751
Mon-Thurs: 8:00am-5:30pm | Fri: 8:00am-4:30pm

Rockledge (Satellite Location)

Animal Specialty & Emergency Hospital
5775 Schenck Ave Rockledge FL 32955
Wednesday & Thursday: 9:00am-3:30pm

© 2023 Veterinary Dermatology Center.
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  • Home
  • New Patients
    • What to Expect
    • Take A Tour
    • Why a Veterinary Dermatologist?
    • Patient Handouts
  • About Us
    • Team
    • Locations & Hours
    • Contact Us
    • Before and After Patient Photos
    • Testimonials
    • FAQs
  • Services
    • Medical Services
    • Allergy Testing
    • Food Allergy and Intolerance
    • Video Otoscopy
    • Anesthesia and Patient Monitoring
    • Flea Prevention and Control
    • Tick Prevention
    • Cutaneous Laser Surgery
  • Pet Health
    • Online Pharmacy
    • How-To Videos
    • News
    • FAQs
    • Pet Insurance Info
    • Links
  • Forms