COMMUNITY your pets wellness/sick appointment

Your pets wellness/sick appointment [one per pet]
TO BE COMPLETED ONLY IF AN APPOINTMENT HAS BEEN MADE

To make an appointment, please call 469-620-2828
Name*

First NameLast Name
If your pet is fearful, reactive, or has a history of aggression, please inform us in advance. We take these cases very seriously and want to ensure the safety and comfort of both your pet and our team. Not disclosing this information prior to your appointment, could lead to a cancellation and losing your deposit
To the best of my knowledge, my pet:*
WHEN IS YOUR SCHEDULED APPOINTMENT?*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Species*
Your Pets Name*
How old is your pet? *
[Leave blank and we will estimate]
Gender*
What services are you wanting done today?
Can you drop your pet off? Drop-off appointments help us see more patients without rushing care. If your pet is sick or injured, we highly recommend a same-day drop-off (no charge) so we can monitor them and create the best medical plan while keeping you updated. Drop-off is between 8–9am, with pickup at 4:30pm unless otherwise arranged by a CHEW team member.*
What vaccinations are needed?*

DHPP (canine)Bordetella (canine)RabiesLeptospirosis (canine)Canine influenzaMy pet is up to date on vaccinations (MUST provide proof of vaccinations)I do not know
What vaccinations are needed?*

Rabies PureVax - see belowRabies - see belowFVRCPFeLVMy Pet is up to date on vaccinations (MUST provide proof of vaccinations)I do not know
What add-on services are you needing?

Microchip $25Anal Gland Expression $15Nail Trim $15-$25Ear Cleaning $15Ear Cytology $35 (if showing any signs of ear irritation)Other
FECAL FLOTATION $18 VERY IMPORTANT parasites can make your pet not only uncomfortable, but it can lead to more serious conditions - even death. Some parasites can be transmitted to humans. Because parasites are very common, a fecal flotation should be done every 6 months
I would like to have a fecal floatation completed - please bring a fresh (same day) sample*

YesNo
If my pet is positive for parasites, please send home 2 rounds of dewormer
HEARTWORM TEST (canine Only) $35 VERY IMPORTANT Heartworm disease is a serious disease that results in severe lung disease, heart failure, other organ damage, and death. A heartworm test is required for any heartworm prevention and is recommended every year
I approve a heartworm test*

YesNo
Send me home with Heartworm/Flea/Tick prevention (Heartworm test required)*

Yes, 1 month ($25-$27)Yes, 6 months ($160-$180)Lets talk about itNot at this time
Triple Test FIV/FeLV/Heartworms (feline only) $35 VERY IMPORTANT Screens cats for feline immunodeficiency virus (FIV) antibody, feline leukemia virus (FeLV) antigen, and feline heartworm (FHW) antigen
I approve a triple test*

YesNo
Send me home with prevention

Yes, send me home with Revolution (Recommended for outdoor cats: flea, tick, heartworms, ear mites, round/hookworms - quantity to be indicated at appointmentYes, send me home with Senergy - flea, heartworms, ear mites, round/hookworms - quantity to be indicated at appointmentDecline, do not send home prevention
Would you like bloodwork done today? Bloodwork is essential for assessing your pet's health, detecting early signs of illness, and monitoring disease progression. Establishing a baseline in young pets allows for comparison in later years. Annual bloodwork in adulthood and senior years helps detect physiological changes and early disease signs.

Basic Bloodwork (CBC/Chem10) $90Intermediate Bloodwork (CBC/Chem17/Lytes) $140CANINE - Comprehensive Bloodwork/Screening (Chem 27, SDMA, CBC, Thyroid, Fecal, Heartworm Test, Urinalysis) $175 (DOGS - ONLY)FELINE - Comprehensive Bloodwork/Screening (Chem 10, SDMA, CBC, Fecal, Triple Test, Urinalysis) $130 (CATS ONLY)OTHER/NOT SURE - Lets talk more about your pet's needs and the best panel for them!
Would you like to add 7 days of Proviable $15 (A clinically researched, veterinarian-recommended probiotic that supports intestinal health and overall wellness. It contains multiple beneficial bacterial strains and prebiotics to help maintain a balanced gastrointestinal microbiome, particularly during periods of stress, dietary change, or antibiotic therapy. Regular use promotes normal digestion, stool quality, and immune function. Backed by thousands of reviews and an average 4.75 out of 5-star rating, Proviable is a trusted choice for digestive support)
Do you have any concerns about your pet? If your pet is sick or injured, please tell us what clinical signs your pet is experiencing, and when they started. Please be detailed:
Do you have any medical records on your pet*

Yes (please upload below)Yes - I will bring them with me - MUST be copies for us to keepNo
UPLOAD MEDICAL FILES HERE:

Upload medical records, vaccination history, radiographs, lab work
Cancelof
What questions do you have about your visit?
I agree to let CHEW take pictures of my pets and use them on social media*

YesNo
PAY IT FORWARD! Would you consider making a small donation today? *This will be added to your deposit below
100% of this donation will go to our Compassion Fund - a fund set aside to help families with diagnostics and/or life saving surgeries

Amount due

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Your pets wellness/sick appointment [one per pet]

TO BE COMPLETED ONLY IF AN APPOINTMENT HAS BEEN MADE