GTKC Health Clinic Registration Form
SATURDAY, AUGUST 24th, 2024 from 9:00 am-2:00 pm
Location: North Ed Career Tech Center, 880 Parsons Road, Traverse City, Michigan

Dr. Sarah E. Achen, DVM, DACVIM will be doing the cardiac exams
Dr. Andras M. Komaromy DVM, PhD, DACVO, DECVO, FARVO will be doing the CAER eye exams


*** If bringing more than one breed, please fill out this form for each one.
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Email *
Registration and full payment is REQUIRED by August 10, 2024
Payments can be made below with Venmo or PayPal.
You can also mail a check to Julie Tripp, 1099 Vega Drive, Traverse City, MI 49696.

Appointments are reserved only after submitting full payment.
No transactions or walk-ins on the day of the clinic.

Your appointment time with any additional instructions will be sent about a week prior to the clinic. Please arrive to your appointment 15-20 minutes early.

An automated confirmation email will be sent once this form is submitted.
Cell Number *
Street Address *
City, State *
Breed *
I will bring ( ? ) dogs for Auscultation only at $55/each. *
I will bring ( ? ) dogs for Auscultation & Echocardiogram for $265/each. *
I will bring ( ? ) dogs for Holter Monitor analysis for $100/each. The monitors are not furnished, this is an analysis only and will be done after all other exams.
 *
I will bring ( ? ) dogs for ACVO Eye Exam (CAER) at $45/each. *
Would you prefer an AM or PM appointment?
We will make every effort to accommodate, but cannot guarantee.
 *
PAYMENT is REQUIRED
Please add up your total due and submit payment in order to complete registration. The deadline to pay and register is August 10, 2024.

PLEASE pay using "Friends & family" ONLY. If fees are incurred, payments will be reversed.

VENMO  or PayPal 
Yes, I paid using: *
Amount Paid *
NO REFUNDS FOR CANCELLATIONS, MISSED, OR LATE APPOINTMENTS.
Owner is responsible for separate OFA fees (not included in cost of clinic services) 

By Signing up: I hereby waive and release the Grand Traverse Kennel Club and its club officers, instructors, assistants, and agents from any and all liability of any nature, for injury or damage which I, my family, guests, or my dog(s) may suffer, including specifically, but without limitation, to any injury or damage resulting from the action of my dog or any other dog. I expressly assume the risk of any such damage or injury while attending this function of the Grand Traverse Kennel Club, or while on the clinic grounds or the area surrounding them.

THANK YOU!
A copy of your responses will be emailed to the address you provided.
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