Telemedicine Check In Form

Telemedicine Check In Form

AMERICAN CANYON VETERINARY HOSPITAL
Please fill out this form in it's entirety and submit at least 1 hour prior to your appointment.
Date

MonthDayYear
Date
Name*

First NameLast Name
Pet's Name*
Phone Number where you can be reached for this appointment*
Please enter a valid phone number.
Would you like to add an alternate phone number?

YesNo
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Please describe your concern about your pet. Please be as descriptive as possible. This will be reviewed by the DVM prior to your consultation.
If you have any pictures or videos of the issue that you are concerned about, please upload it here.

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