Email Consultation Form

Email Consultation Form

Submit an email consultation and Dr. Carrie will write back to you within 2 business days.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Pet's Name *
Species *

Dog Cat
Sex of Pet *

Neutered Male Spayed Female Intact Male Intact Female
Breed of Pet *
Age of Pet (can be approximate) *
Weight of Pet (can be approximate) *
Main Health Concern for your Pet *
Please be as detailed as possible
How long has this been a concern? *
Secondary Concerns
Anything else you'd like to discuss with the veterinarian
Current Food and Amount *
Please list brand of food, type of food, and how much is fed through the day
Current Treats
Brand of treats and how often they are given
Appetite *
Is your pet's appetite normal, increased or decreased? Are they food-motivated or finicky?
Water Consumption *
Is your pet's water consumption normal, increased or decreased?
Urination *
Is urination normal, increased or decreased? If you have a cat, are letterbox habits normal?
Defecation *
Is defecation normal, or is your pet experiencing diarrhea, soft stool or constipation? If so, how long has this been occurring?
Vomiting
Has your pet been vomiting recently? If so, how often has this been happening?
Coughing / Sneezing
Have you noticed any coughing or sneezing or discharge from the eyes or nose? If so, how long has this been going on?
Supplements
Please list all supplements you are currently giving your pet, including brand and dosing amount and frequency.
Discontinued Supplements
Are there any supplements you've tried in the past and have stopped?
Medications
Please list all medications your pet is currently taking, including name, dosing amount and frequency of administration.
Are Supplements / Medications Helping Your Pet's Current Issue?
What effect are these having on your pet's overall health (if you are able to answer, if not, no worries!)
Medical History *
Please give a description of your pet's medical history, including age of onset, diagnoses and resolution, if applicable.
Additional Issues
Anything else to add, or that you'd like to have addressed?
File Upload

Please attach medical history here. Can also be emailed to us at info@fullcirclepet.com
Cancel of

Checkout *

Email Consultation -- New Patient This is for new patients with health concerns, includes a record review and a response from the veterinarian within 2 business days.

$ 65.00

Email Consultation -- Current Patient This is for patients currently or recently under the care of Dr. Carrie and Full Circle Vet.

$ 45.00

Total

$ 0.00

Credit Card Payment
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