Request an Appointment
Please note: do not use this form if you have an emergency. Call us at (563) 886-6312 if this is urgent. This is an appointment request. We will confirm your pet's appointment time with you via email or phone.
I am a/an
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New Client
Existing Client
Which clinic for this visit?
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Tipton Location
New Liberty Location
Existing clients - Are you bringing?
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A new patient
An existing patient
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Pet's Name
*
I would prefer
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A morning appointment time
An afternoon appointment time
A Saturday appointment
No preference/Soonest available
Is the patient a cat or dog?
*
Please Select
Cat
Dog
Has the patient been surgically altered?
*
Please Select
Yes
No
Patient's age
*
Patient's age (days, months, years)
*
Please Select
Days
Months
Years
Patient's sex
*
Please Select
Male
Female
Patient's breed
*
Patient's color
*
Describe reason for your pet's appointment.
*
How would you like to be contacted?
*
Text
Phone call
Email
Upload Pet Health Records
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