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 5-7 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.

Owner Information

Owner First Name

Owner Last Name

Secondary Owner / Authorized Agent Name

Primary Phone

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.

Address

City

State

Zip Code

How did you hear about us?

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

About Your Pet

Call Name

Registered Name

Breed

Gender

Spayed or Neutered?

Date of Birth

Microchip Number

Tattoo Number

AKC Registration Number

Other Registration Number

Has your dog ever come to us for an OFA or exam previously?

Fees: As of January 2023: First dog: $75. Additional dogs: $75 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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OFA Examinations Form

Owner Information

About Your Pet

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