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Health Screening Registration

Please use this form to schedule and make a donation toward IWF health screening. Your donation helps defray the cost to the IWF for each test.

You will be contacted with your scheduled time, and if we need additional information.

If you have any questions, please email Frances Abrams at iwfhealth@gmail.com or call her at 937-371-3609.

Owner Contact Information
Please note all contact information is required.
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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cell phone preferred so we can contact you at the show site
Testing Information
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Please indicate which show you are scheduling screening for.
This show has multiple testing days for heart screening. Please select your preferred day.
We will try to accommodate your preference in scheduling.
DOG INFORMATION




(mm/dd/yyyy)




Additional Donation
$
PLEASE ENTER PAYMENT INFORMATION ON THE NEXT SCREEN