New Client Form

Please schedule an initial consult appointment before filling out this form. To schedule a consult with one of our Dermatologists, please have your veterinarian email a referral to info@pittvetderm.com or fax it to 724-426-7717.

Once the referral is reviewed, we will call you to schedule an appointment. If you are having difficulty with the form not submitting and you are using a smart phone or a tablet, please try to fill it out on a computer.