FPMVC Apt Request Form

Appointment Request

This form is to initiate an appointment request. Submitting this form does not guarantee availability. Please fill out form completely. Once received, we will text or email you to finalize appointment details.
Full Name

First NameLast Name
Phone

Area CodePhone Number
E-mail
Do you prefer email or text for communication?
Pet’s Name
Species
Breed
Age
Service Required

Quality of Life Consult (this appointment is for pet parents who feel their pet’s day-to-day comfort and wellbeing is declining; Dr. Wagner will perform a physical exam, review your pet’s medical history and have an in-depth discussion with you regarding her analysis of Quality of Life. An individualized treatment plan will then be developed for your pet which can include pain control medication or hospice care.)
Approximate Weight (lbs.)
For Euthanasia Requests, please acknowledge the following information: Family Paws Mobile Veterinary Care does not provide aftercare services of your pet’s body. It is your responsibility to make such arrangements prior to Dr. Wagner’s arrival. We recommend 2 local pet crematoriums; their information is listed on our webpage www.fpmvc.com. (Click the “Service Area & Pricing” Tab). :
Does your pet require any special handling for aggressive behavior? Please explain.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What time works best for you?
Any additional info you'd like us to be aware of?
Should be Empty:

Appointment Request