• Leading Long Island Veterinarians in Referral Medicine
    24 Hour Specialty & Emergency Services
    75 Sunrise Hwy, West Islip, NY 11795-2033

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    631.587.0800

VMCLI
  • Services
    • Acupuncture
    • Avian & Exotics
    • Cardiology
    • Critical Care
    • Dentistry
    • Dermatology
    • Emergency
    • Internal Medicine
    • Neurology
    • Medical Oncology
    • Radiation Oncology
    • Ophthalmology
    • Physical Therapy
    • Surgery
  • Continuing Education
    • COVID-19 Helpful Information
    • Understanding & Maintaining NY Controlled Substance Compliance
    • Hazardous Communication & Global Harmonized System Training
    • Introduction to Radiation Safety
    • Proper Animal Handling & Restraint
    • Bloodborne Pathogens Overview
    • MRI Safety Training
    • Current CE Events
    • Past CE Events
  • Articles
  • Resources
    • Pet Loss & Grief
  • About Us
    • What’s a Veterinary Specialist?
    • AAHA Accreditation
    • Meet the Vets
    • Management Personnel
    • Meet the Staff
    • Testimonials
    • VMCLI Gives Back
    • The Sydney Memorial Fund
    • Policies
    • Client Feedback
  • Careers
    • Internships & Residencies
  • Employees
    • E-mail
    • EZ-Labor
    • ADP TotalSource
  • Referring Veterinarians
    • RDVM
    • RDVM Referral Form (PDF File)
    • VMCLI Info Sheet (PDF File)
  • DONATE TO HELP PETS IN NEED
    • VMCAA Success Stories
  • Services
    • Acupuncture
    • Avian & Exotics
    • Cardiology
    • Critical Care
    • Dentistry
    • Dermatology
    • Emergency
    • Internal Medicine
    • Neurology
    • Medical Oncology
    • Radiation Oncology
    • Ophthalmology
    • Physical Therapy
    • Surgery
  • Continuing Education
    • COVID-19 Helpful Information
    • Understanding & Maintaining NY Controlled Substance Compliance
    • Hazardous Communication & Global Harmonized System Training
    • Introduction to Radiation Safety
    • Proper Animal Handling & Restraint
    • Bloodborne Pathogens Overview
    • MRI Safety Training
    • Current CE Events
    • Past CE Events
  • Articles
  • Resources
    • Pet Loss & Grief
  • About Us
    • What’s a Veterinary Specialist?
    • AAHA Accreditation
    • Meet the Vets
    • Management Personnel
    • Meet the Staff
    • Testimonials
    • VMCLI Gives Back
    • The Sydney Memorial Fund
    • Policies
    • Client Feedback
  • Careers
    • Internships & Residencies
  • Employees
    • E-mail
    • EZ-Labor
    • ADP TotalSource
  • Referring Veterinarians
    • RDVM
    • RDVM Referral Form (PDF File)
    • VMCLI Info Sheet (PDF File)
  • DONATE TO HELP PETS IN NEED
    • VMCAA Success Stories

Dermatology Admission Form

  • What skin problem are you bringing your pet in for?
  • How old was your pet when the skin problem first started?
  • Did the problem start suddenly or gradually over time?
    Is the problem worse during certain times of the year?
    Check all that apply
    Has your pet ever had an ear infection?
    Check all that apply
    Is your pet itchy (this includes any licking, chewing, rubbing, biting, or scratching)?
  • Rate your pet’s level of itch on a scale of 0 (no itch) to 10 (your pet’s most severe itch). Write a number 1 to 10 here
  • List the locations on your pet’s body where they are itchy
    What did you notice first (choose one)?
  • List ALL medications your pet is CURRENTLY taking (including any topicals, supplements, or medications for other conditions not related to the skin). Indicate the response to these treatments if known.
  • List PREVIOUS medications used to treat your pet’s skin/ears (including any topicals or supplements). Indicate the response to these treatments if known.
    Is your pet primarily (choose one)
  • What flea/tick prevention are you using?
    When is the flea / tick prevention given?
  • What heartworm prevention are you using?
    When is the heartworm prevention given?
  • What other pets are in the household?
    Are the other pets primarily?
    Are the other pets in the household receiving flea/tick prevention?
  • What type of flea / tick prevention do the other pets get?
  • Does your pet have contact with any animals outside of your home (list location and types of animals)?
    Do any other pets or people in the household have skin problems?
  • What do you feed your pet (include treats, chews, table food, etc.)?
    Does your pet have a sensitive stomach associated with feeding different types of food (ex. vomiting, diarrhea, etc.)?
  • Have different diets been tried as treatment (list brand name & duration given)?
  • Does your pet have any travel history (list location)?
  • List any other diagnosed medical illnesses.

Client Services Center

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  • Make A Payment

Once the payment is made and confirmed, a copy of the payment should be emailed to VMCLI@VMCLI.com

  • Refill your Pets Prescription or Specialty Diet
  • Pet Portal Login
  • Request or Change an Appointment
  • New Client Early Check In
  • Physical Rehabilitation Check In
  • See What Our Clients Say About Us!
  • Dermatology Admission Form

VMCLI
75 Sunrise Hwy
West Islip, NY 11795-2033

[Get Directions]

Phone: 631.587.0800
Fax: 631.587.2006

New York State
Veterinary Medical Society
Accreditation Certificate

Join Our Mailing List

Emergency Resources

Common Emergencies
Emergency Preparedness

VMCLI Forms*

New Client Registration Form
Ophthalmology Questionnaire
RDVM Referral Form (Veterinarian’s only)
VMCLI Info Sheet (Veterinarian’s only)

The VMCLI is Now Offering
Stem Cell Treatments!

Stem Cell Intro Poster
Stem Cell Flyer

Special Announcements:

Welcome Dr. Morgenstern!

*Adobe® Reader® is required.

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Copyright © 2010 – 2017 Veterinary Medical Center of Long Island. All rights reserved. Privacy | Legal
75 Sunrise Hwy, West Islip, NY 11795-2033 | 631.587.0800

SERVICES

Veterinary Acupuncture
Avian and Exotics
Cardiology
Critical Care
Dentistry
Dermatology
Emergency
Internal Medicine
Neurology
Oncology
Ophthalmology
Physical Therapy
Surgery

  • Services
    • Acupuncture
    • Avian & Exotics
    • Cardiology
    • Critical Care
    • Dentistry
    • Dermatology
    • Emergency
    • Internal Medicine
    • Neurology
    • Medical Oncology
    • Radiation Oncology
    • Ophthalmology
    • Physical Therapy
    • Surgery
  • Continuing Education
    • COVID-19 Helpful Information
    • Understanding & Maintaining NY Controlled Substance Compliance
    • Hazardous Communication & Global Harmonized System Training
    • Introduction to Radiation Safety
    • Proper Animal Handling & Restraint
    • Bloodborne Pathogens Overview
    • MRI Safety Training
    • Current CE Events
    • Past CE Events
  • Articles
  • Resources
    • Pet Loss & Grief
  • About Us
    • What’s a Veterinary Specialist?
    • AAHA Accreditation
    • Meet the Vets
    • Management Personnel
    • Meet the Staff
    • Testimonials
    • VMCLI Gives Back
    • The Sydney Memorial Fund
    • Policies
    • Client Feedback
  • Careers
    • Internships & Residencies
  • Employees
    • E-mail
    • EZ-Labor
    • ADP TotalSource
  • Referring Veterinarians
    • RDVM
    • RDVM Referral Form (PDF File)
    • VMCLI Info Sheet (PDF File)
  • DONATE TO HELP PETS IN NEED
    • VMCAA Success Stories

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