Carriage Crossing - Telemedicine Consults

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We are happy to book an appointment for you. This is not an automatic process. Once we receive your request, we will contact you to confirm a date and time that is as close to your request as possible.

This form should only be used for requesting appointments that will take place at least 2 full business days after the time of the submission of this form.

If your appointment has not been confirmed within 24 hours, please feel free to contact the practice by phone to confirm.
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First Name
Last Name
Email
Phone
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Pet Name
Cat
Dog
Pet's Species
Male
Female
Male Neutered
Female Spayed
Sex
DOB or Age ( x years or months )
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Preferred Date
Date
Month
Day
Year
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Preferred Time* This field is required.
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2
3
4
5
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7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
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Reason for appointment* This field is required.
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How did you hear about us?Check all that apply.
Google Search
Social Media
Driving by Hospital
Friend or Family Member
Other
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If Other, Please Specify
Should be Empty: