Schedule Appointment
Just a few quick questions..
Ok... let's get started.
Please tell us who you are
Please Tell Us Who You Are
My First Name
My Last Name
My Email
example@example.com
My Cell Phone Number
Please enter a valid phone number.
Other Phone (if applicable)
e.g. significant other/emergency contact
Who/What is the other phone #?
How do you prefer to be contacted?
Please Select
Voice - My Cell Phone
Text Message (my cell)
email
Voice-Other Telephone
your - Dover Shores App/Chat
We will try that first.
My Pet's Name:
Dog/Cat?
Please Select
Dog
Cat
Other
Which Other Species?
Boy/Girl?
Please Select
Boy
Girl
Not sure
Breed?
What issues do you want us to address:
List all your concerns / please be specific.
If your pet is on medication, Do you need refills?
Please Select
Yes
No
Not Sure
Name / Descriptions of Needed Medications:
What time of day is your preference?
Please Select
ANY TIME - MY PET'S PROBLEM IS URGENT
Any time - I'm flexible
early morning
late morning
early afternoon
What time of day is your second choice?
Please Select
ANY TIME - MY PET'S PROBLEM IS URGENT
Any time - I'm flexible
early morning
late morning
early afternoon
What day of the week is your preference?
Please Select
First Available
Tuesday
Wednesday
Thursday
Friday
Saturday
What day of the week is your Second choice?
Please Select
Tuesday
Wednesday
Thursday
Friday
Saturday
Is there anything else we should know?
Submit
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