James W Smith Memorial Health Clinics

Please use 1 form per dog. Use the forms at the top or bottom of the page to download for the thyroid and CHIC DNA applications. After filling out the forms for thyroid and DNA upload to this form. Once you click on SUMBIT, you will be taken to the Shop for payment.

If you have any questions, please contact Kelly Flannigan, DVM

Your First and Last Name *

Owner's Name *

Your Phone Number *

Your Email *

Dog Information

Registered Name of Dog *

AKC Registration Number *

Field Name *

Male Female

Dog Date of Birth *

Select tests requested *

Thyroid Profile ($100) Microchip ($25) CHIC DNA collection (FREE)

Upload files for Thyroid and or CHIC DNA Collection

Thyroid Application

CHIC DNA Collection

Any Additional Information

Send a copy to myself

OFA Thyroid Application

CHIC DNA collection