
New Clinic Matching Goods Authorization
Clinic Name______________________________________
Veterinarian(s)____________________________________
Address_________________________________________
City_________________State____Zip__________
A veterinary hospital, opened or purchased within the last 90 days, that is owned and operated by a licensed veterinarian.
8909 Iverleigh Court
Potomac, Maryland 20854
301-983-8387
800-755-4738
Fax 301-365-0191
E-mail dermapet@aol.com