Dr. Allen will be at your barn on:________________________________________________________

Coordinator:_________________________________contact info:_______________________________

HORSE OWNERS or their representative, MUST BE PRESENT AT TIME OF SERVICE.  SORRY, WE DON'T BILL

PLEASE: one horse (or 2 miniature horses) per time slot.  Thank you!

THE NUMBER OF HORSES SCHEDULED CAN EFFECT THE STARTING TIME.  IF A FULL DAY WAS ANTICIPATED BUT A PARTIAL DAY RESULTS, PLEASE CONTACT OUR OFFICE ABOUT THIS CHANGE SO THAT WE CAN ADJUST OUR SCHEDULE & THE TRIP'S LOGISTICS.  THANK YOU.

TIME (approx.)

HORSE

OWNER

PHONE

+15% IF NO CHECK

1)    9 a.m.

2)   9:30 a.m.

3)   10:00 a.m.

4)   10:30 a.m

5)   11:00 a.m.

lunch break ?

6)    12:30 p.m.

7)    1:00 p.m.

8)    1:30 p.m.

9)

10)

11)

DEPOSITS ARE SOMETIMES TAKEN IN ORDER TO RESERVE EACH TIME SLOT.  THESE ARE NON-REFUNDABLE BUT WILL BE APPLIED TO THE DENTISTRY ON THE DATE/TIME RESERVED.  DEPOSITS ARE $50.00 ON UP.  CHECKS SHOULD BE MADE TO DR. TOM ALLEN AND HAVE YOUR HORSE/HORSE'S NAME ON THE CHECK.

TO AVOID LOOSING YOUR DEPOSIT, FIND SOMEONE TO TAKE YOUR APPOINTMENT TIME.