Schedule a Session
  1. Complete and Submit the form below
  2. We will email you a date and time for your telephone session with Laurie
  3. Confirm your appointment by submitting payment (email will provide instructions)
  4. Laurie will telephone you at the appointed time
Complete the form below below and click Submit


About You
Name                          

Phone                         

                               
* This is the phone number Laurie will call for your session
City and State             
Email Address             
Re-type Email Address 


About Your Dog
Dog's Name                 
   
Dog's Breed                                                     
Dog's Age   
       Dog's Weight 
Has your dog been spayed/neutered? Yes No

Describe the diet you feed your dog


List any supplements your give your dog

Type of Cancer    Date of Diagnosis 

Suggested Treatment Plan      


Five most important questions you want to ask Laurie
1  
2  
3  
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5  


Provide a brief Medical background of your dog's cancer Diagnosis & Treatment: (Max: 250 characters)

When are you available for your phone session?
20-minute phone call, to begin at 10am, 10:30, 11, 11:30, 12pm, 12:30, 1 or 1:30
Type desired times beside days that work for you (provide at least 3 possibilities).

Check the days/times that you are available for a phone session

Monday
10am  10:30am    11am  11:30am  12pm  12:30pm  1pm  1:30pm
Tuesday
10am  10:30am    11am  11:30am  12pm  12:30pm  1pm  1:30pm
Wednesday
10am  10:30am    11am  11:30am  12pm  12:30pm  1pm  1:30pm
Thursday
10am  10:30am    11am  11:30am  12pm  12:30pm  1pm  1:30pm
Friday
10am  10:30am    11am  11:30am  12pm  12:30pm  1pm  1:30pm
If you were referred to Ask Laurie through an online support group:
Web Address of Group
Group Code (if any)       
 
Fax us your dog's diagnostic report describing cancer
Fax a biopsy report if your dog has a tumor
If you do not have the reports, call your clinic and ask them to fax to us

FAX (914) 206-4301