Owner's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Registered Name* Breed* Microchip/Tattoo Number* AKC registration number* Date of Birth MM slash DD slash YYYY Registration number of Sire and Dam* Please select the services you are interested in: OFA Shoulder Radiograph Study OFA Hips and/or Elbow Radiographic Study OFA Tracheal Hypoplasia Radiographic Study (for Bulldogs and Brachycephalic breeds only) OFA Basic Cardiac Exam OFA Dentition Exam OFA Patellar Luxation Exam OFA Thyroid Lab-work OFA Kidney Lab-work
