2007 LaSalle Brittany Club Wellness Clinic Wednesday April 18th. 2007 American Legion Hall 17423 67th Ct. Tinley Park, IL Scheduled start of 7PM or earlier depending on number of dogs participating. PRE-REGISTRATION/NOTIFICATION REQUIRED BY 4/11/2007 Dr. David Gonsky will be the Veterinarian for the LaSalle Brittany Club annual clinic. A brief physical exam along with shots requested will be done. NonBrittany’s also welcome. Dr. Gonsky went to school at the University of Illinois, DVM class of 1997. His first practice was at Blum Animal Hospital in Chicago where he enjoyed internal medicine. After Blum Dr. Gonsky went to Evergreen Park and relief Veterinarian at other clinics. Dr. Gonsky’s current practice is to make house calls in Chicago and the immediate vicinity. To register for the LaSalle Brittany Club Wellness Clinic held at the American Legion Hall, 17423 67th Ct., Tinley Park, IL with a scheduled start time of 7PM. May be earlier depending on number of dogs participating send information to: Douglas Drmolka 1704 English St. Rock Falls, IL 61071 or Drmolkad@hotmail.com preferred or call 815-899-0268 Phone contacts please give your name, contact number and number of dogs to be treated and I will return your call within 24 hrs Email contacts fill out form and email or send information in body of email. You will be replied to by email within 24 hrs. Snail mail send as quickly as possible. You will be called when your form is received. See form below Number of Dogs: _______ Phone: _________________ Name ___________________ Street Address_____________ City _________ST___ Zip____________ County______________ # Total # Total Heartworm Test $22.50 Bordetella $17.55 DA2PP(no Corona) $20.90 Fecal Ova & $21.85 Parasite Check (Please bring fresh peanut sized sample) DA2PPC (with Corona, $23.90 Fecal Ova & $31.85 suggested for puppies) Parasite Check + Giardia Screen (Please bring fresh peanut sized sample) DHP (No Corona, No Lepto) 3yr Lyme Distemper/Parvo Vaccine Titer Heartworm Preventative Brand (Sold as 12 pack): (The brand with majority preference will be available. Lower weight sizes can be ordered if demand is sufficient) $41.30 $21.10 $70.45 Rabies Vaccination (1 year) Rabies Vaccination (3 year) Lepto/4 way ICGP Flea and Tick Preventative Brand (Sold as 6 pack): (The brand with majority preference will be available. Lower weight sizes can be ordered if demand is sufficient) $20.45 $38.70 $20.70 Heartgard 26-50 Heartgard 51-100 Interceptor 26-50 Interceptor 51-100 AVID Microchip Total Column A $62.90 $78.10 $62.90 $83.10 Frontline + 23-44 Frontline + 45-88 Advantix 21-55 Advantix 56 + $86.00 $91.00 $82.20 $85.10 $29.00 Total Column B Grand Total: ____________ *Special Request_________________________________________________________ *All Special requests will be considered, but may not be granted due to site and time restrictions. You will be notified on a case by case basis. ** With the exception of Cook County for which tags will be available ($6.00 1 year, $18.00 3 year), the responsibility for obtaining the county tag will be the dog owners. A copy of the rabies certificate will be provided and a second copy sent to the respective county as a record.