Appointment Request

1
Your Name* This field is required.
First Name
Last Name
2
Primary Phone Number* This field is required.Cell phone # with texting enabled is preferred (for automated appointment confirmations, reminders, and form submissions.) Please add (513)553-9954 to your phone book!
Please enter a valid phone number.
3
Email* This field is required.Email is required so you can receive copies of all forms, the consultation report, and a journal that you can print to use at home to help monitor your pet's progress.
example@example.com
4
AddressYour physical location is helpful to determine what products you will have available locally in the event we choose a cannabis product that is not available online.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Pet's Name* This field is required.
6
Species* This field is required.
Dog
Cat
7
Sex* This field is required.
Female, Intact
Male, Intact
Female, Spayed
Male, Neutered
8
Breed* This field is required.
9
Birthday* This field is required.If you do not know your pet's exact birthday, a general estimate is ok!
Date
Year
Month
Day
10
Appointment Type* This field is required.Considering your chief complaint and desired goals for your pet, what kind of case is this?
Neurology
Oncology
Anxiety/ Behavior
Orthopedic
General
11
Medical History & Goals* This field is required.Please briefly describe your pet's current medical concerns and what goals you have when considering initiating treatment with a cannabis product.
Huge
Large
Normal
Small
Ok
Ok
12
Appointment Request- First Choice* This field is required.I will try my best to accommodate your request, however I cannot guarantee your preferred time will be available. Please wait for your appointment confirmation before adding to your calendar!
13
Appointment Request- Second ChoiceFeel free to request up to three days and times that work best for your schedule.
14
Appointment Request- Third ChoiceFeel free to request up to three days and times that work best for your schedule.
15
Please allow 24 to 48 hours for me to review your appointment request. Once scheduled I will email/text you an appointment confirmation.

Prior to the appointment you will be contacted for payment over the phone for the consultation. The initial consultation is $75.00 and includes the one-on-one consult (up to one hour via phone or video chat), medical records review, product choice and/or review, Certificate of Analysis review, dosing and administration guidance, and follow-ups via email.

If you need an additional one-on-one follow up after the first consult to address multiple questions, review dosing, or other questions it is $45.00 for up to 30 minutes via phone or video chat.

If you have any questions feel free to contact me via email at SmessnerVCC@gmail.com.
Should be Empty: