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Please complete the following information and one of our sales representatives will contact you.

Business Name:
Doctor's First Name:
Doctor's Last Name:
Street Address 1:
Street Address 2:
City:
State/Province:
Country (if outside the US):
Postal Code:
E-mail:
Voice Telephone Number:
Fax Telephone Number:

How soon are you looking to build? -- Choose just one.
Within a year
1 to 2 years
2 to 3 years
3 to 5 years
over 5 years

LAND

Do you have a lot?
Yes No

If so, is it zoned for building a clinic and/or kennel?

Yes No

 
Size of lot:
ft. x ft.
 
Type of road frontage: -- Select all that apply.
State Highway
County Road
City Road

If so, do you already have access to the road?

Yes No

BUILDING

Do you have a suggested floor plan?
Yes No
 
Do you have an estimate of the total sq. ft. that you would like for your clinic to be?
sq. ft.
 
How many stories?
1 2 3
 
Type of exterior: -- Select all that apply.
Brick
Stone
Hardy Plank
Vinyl
Stucco
Other:
 
Basement:
Partial Full None
 
How many exam rooms?
 
How many surgery rooms?
1 2 Other:
 
Are you wanting a kennel area?
Yes No

If so, how many inside runs?

How many outside runs?

How many inside/outside divided runs?

How many dog cages?

How many suites?

How many cat cages?

How many cat condos?