Dallas Veterinary Clinic - Appointment Request Form

1

Please fill out the form to request an appointment. Once we've received your form, we will give you a call or email to confirm an appointment date.

2

What appointment type would you prefer?* This field is required.

In Person

Curbside

Inpatient Care

3

One person may come directly into exam room, stay seated in designated place. I agree to wear a proper mask over my mouth and nose the entire time in the building. Scarves/Bandanas/Gaiters are not permitted. I promise not to argue with the DVC team or give opinions about mask wearing since I have the alternate option to stay outside during my pet's appointment or inpatient care drop off, and I understand that everyone must wear a mask regardless of vaccination status.* This field is required.

I agree

4

Covid Screening Questions* This field is required.

Have you been exposed to anyone who has tested positive for COVID-19 in the past 14 days?

Have you experienced any COVID-19 symptoms in the past 7 days?

5

Please remain in the parking lot for the duration of your pet's appointment. Please keep your phone charged and available so the Doctor or Technician can reach you to discuss your pet's appointment and any treatment plans/instructions.

6

I am in this vehicle* This field is required.

7

An inpatient care fee for a well visit is $20 and any stays over 2 hours will incur a $70 hospitalization fee. I agree to schedule a pick-up time (5 min). I am aware that DVC closes at 5:30pm on weekdays/12pm Saturdays. I agree that if I cannot schedule a time to pick up my pet BEFORE closing time, I will pay for overnight unsupervised boarding. I have read and agree to the policies & requirements in the "Pet Hotel & Spa/Daycare Consent form". I will complete & submit the form now or I have already submitted the Hotel/Spa consent form since April 2021. I understand my pet will not be taken into the clinic without this consent on file.

8

Your Information* This field is required.

First Name

Last Name

Phone

Email

9

Pet Name #1* This field is required.

10

What is your pet being seen for?* This field is required.

11

Would you like to add another pet?* This field is required.

Yes

No

12

Pet Name #2* This field is required.

13

What is your pet being seen for?* This field is required.

14

Would you like to add another pet?* This field is required.

Yes

No

15

Pet Name #3* This field is required.

16

What is your pet being seen for?* This field is required.

17

Appointment Information* This field is required.Please list three dates and times that work best for an appointment.

18

No-shows or late cancellations with less than 24 business hours notice will be charged $75 for doctor appointments, or $25 for technician appointments.

Pre-payment of the exam/consult or tech visit fee may be required after no-shows/multiple reschedules, and a deposit is required to book a surgery, which is non-refundable without 3 business days notice.

Please Initial * I understand and agree to the late cancellation fee policy.

19

Appointment Type Requirements

In Person Appointment Requirements:

One person will be permitted to accompany their pet for the appointment. A proper mask must be worn over your mouth and nose for the entire time you are in the building. Scarves/Bandanas/Gaiters are not permitted.

Curbside Appointment Requirements:

Please remain in the parking lot for the duration of your pet's appointment. Please keep your phone charged and available so the Doctor or Technician can reach you to discuss your pet's appointment and any treatment plans and instructions.

Inpatient Care Appointment Requirements:

Inpatient care fee for well visits is $20, any stays over 2 hours will incur a $70 hospitialization fee. Your pet must be picked up by 5:30pm on weekdays, or by 12pm on Saturdays. If you pick up your pet after closing hours an overnight boarding fee will be applied. You must also read and agree to the policies and requirements in the "Pet Hotel & Spa / Daycare Consent form". You will be directed to complete the form when you submit this completed Appointment form.