COMMUNITY your pets wellness/sick appointment

Confirm 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
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?
Is your pet sick or injured? If yes, we highly recommend your pet stay with us for the day (FREE of charge). This will give us time to monitor your pet and come up with the best medical plan, while keeping you informed. Drop off is between 8-9am
What vaccinations are needed?*

DHPP (canine)Bordetella (canine)RabiesLeptospirosis (canine)My pet is up to date on vaccinations (MUST provide proof of vaccinations)Canine influenzaI 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-$20Ear Cleaning $15Ear Cytology $38Other
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 approve a fecal flotation:*

YesNo
If my pet is positive for parasites, send home a dewormer

YesNoI didn't approve a fecal flotation
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 ($120-$155)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

1 month Senergy Topical3 months Senergy Topical6 months Senergy TopicalNo prevention at this time
RECOMMENDED BLOODWORK $90 VERY IMPORANT (Chem 10 & CBC with reticulocytes) Bloodwork allows us to assess your pets symptoms he/she cannot see or feel, such as indicators of liver disease or diabetes. In healthy pets, blood work helps establish a “baseline” for your companion animal.
I approve the recommended bloodwork*

YesNoLet's talk about it
Senior Wellness $160 VERY IMPORTANT Chem 17, CBC, Reticulocytes, Total T4, SDMA, Urinalysis & Intraocular Pressure. Monitoring your older dog's health makes it easier for us to detect minor changes that signal the onset of disease or deterioration of an existing condition
I approve a Senior Wellness panel*

YesNoLet's talk about itN/A, my pet is not a senior
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
We would really appreciate your support! Did you know our hourly overhead is $315? Did you know more than 90% of CHEW's patients are sick or injured? Families are desperate to find a clinic to help them care for their companion, at an affordable price. We need your support so we can continue providing care to the pets who need us most! Any amount will help, every dollar adds up! This amount will be added to the deposit below.

TO CONFIRM YOUR APPOINTMENT, A $25 DEPOSIT IS REQUIRED *this will be applied towards your balance*

USDA DEPOST OF AT LEAST $25 IS REQUIRED 24 HOURS PRIOR TO YOUR APPOINTMENT

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Confirm your pets wellness/sick appointment [one per pet]

TO BE COMPLETED ONLY IF AN APPOINTMENT HAS BEEN MADE