Contact Us Contact Us Via Telephone: (845) 462-6300 – OR Email: firstname.lastname@example.org If you have a question you would like to ask Dr. Weiss or would simply like us to contact you, please complete the following form. Please note: Fields in red are required. Your First Name: Your Last Name: Address: City: State: Zip: Daytime Phone: e-mail: Are you already a client? Yes No Would like to be Your Pet’s Name: What type of pet do you have? (dog, cat, bird etc) What is your pets age? What is your pets gender?MaleFemaleDon’t Know/Not Sure Is your pet sick now? Yes No What is the problem with your pet? Would you like to schedule an appointment? Yes No If yes, what is best time to contact you?MorningAfternoonEvening Question or additional information we may need to know. How did you hear about us?