Northwest Animal Eye Specialists

13020 NE 85th Street
Kirkland, WA 98033

(425)827-3966

www.northwestanimaleye.com

  

Please fill out as much information as possible when filling out this form as it will be transcribed onto the OFA certification form. Please note that OFA/CERF screenings are generally used for breeding dogs and are only a general screening for genetic/inherited issues, it is not a full exam intended for pets with eye issues. Once you have submitted your information, we will get back to you via email or phone within 2 business days with options for scheduling your pet. We recommend you use Google Chrome, Safari, or Mozilla Firefox to fill out this form. Please contact us if you need assistance filling out this form.

OFA/CERF Screening

About You
Owner Name: (required)
First Name (required)
Last Name (required)
Owner Phone Number: (required)

Please note that we send appointment reminders via text. If you prefer to receive appointment reminders via email or are not able to text, please let our staff know and we will gladly accommodate you.

Owner E-Mail Address: (required) :
Owner Address: (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Co-Owner Name:

Would you prefer our Renton or our Kirkland location? (required)

Renton
Kirkland
Either is fine


About Your Pet
Call name: (required)

Registered name: (required)

Breed: (required)

Sex: (required)

Male
Female
Male Neutered
Female Spayed


Date of birth:

Microchip number:

Tattoo number:

AKC registration number:

Other registration number:


Fees: First dog: $65 Additional dogs: $60 each Payment is required at time of service. We may require pre-payment if you have multiple dogs or if you have failed to show for appointments in the past.

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