Wellness Appointment Request Form

Thank you for your interest in a Wellness appointment at the Sandhills Spay Neuter Veterinary Clinic (SNVC), located at 5071 US Hwy 1 N, Vass NC 28394!

Please fill out the information below. At this time, all wellness appointments are scheduled on Thursdays. We do require a $25.00 deposit for your wellness apppointment. This deposit will be used towards your scheduled visit. This deposit is NON-REFUNDABLE if your appointment is canceled/rescheduled with less than a 48 hour notice OR if you do not show up for your scheduled appointment.
Wellness Appointment Request Form

Sandhills Spay Neuter Veterinary Clinic - SNVC
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you currently receiving financial assistance such as Medicaid, Food and Nutrition, WIC, etc.?*

YesNo
If you answered YES to receiving financial assistance, please provide a copy of your benefits letter that includes a current date range.

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Patients Name *
Is your Pet spayed or neutered?*

YesNo
Do you have a Male/Female/Cat/ or Dog*

FEMALE CatMALE CatFEMALE DOGMALE DOG
Patients Color and Breed*
Patients Approximate Weight*
Patients Approximate Age (weeks, months, or years)*
You can now Take a Photo or Upload a Photo of your Pet for their medical record!
Patient Photo Upload

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Are you requesting an appointment for more than one Pet? If you answer yes, please complete a new form per pet.*

YesNo
Has your pet ever had vaccines or seen a veterinarian*

Yes, my Pet has seen a VeterinarianNo, my Pet has never been to see a Veterinarian
Please provide a copy of your Pets vaccine history if available

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*** ALL WELLNESS VISITS INCLUDE A $35.00 EXAM FEE ***
Please check which services you would like at the time of your Pets wellness appointment

Nail Trim ($25.00)Ear Cleaning ($20.00)Anal Gland Expression ($25.00)Bravecto-Flea/Tick Prevention ($60.00 for a 3 month supply)Microchip ($30.00 - includes lifetime registration)Rabies Vaccine ($15.00)Canine DHPP vaccine ($20.00)Canine Lepto vaccine($20.00)Canine Bordetella ($20.00)Canine Heartworm Test ($30.00)Iverhart Max (Canine) single month dose ($12.00)Iverhart Max (Canine)-heartworm prevention 6 month supply ($55.00)Feline FVRCP vaccine ($20.00)Feline leukemia vaccine ($20.00)Feline leukemia and FIV test ($35.00)Capstar tablet - immediate flea infestation treatment ($15.00)Fecal Exam ($25.00)Deworming (pricing is based on patients weight)
Do you have any additional information on your Pet to provide?

My Products

Appointment Depositincludes 4% merchant fee ($1.00)

$26.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please verify that you are human
Should be Empty:

Thank you for your interest in a Wellness appointment at the Sandhills Spay Neuter Veterinary Clinic (SNVC), located at 5071 US Hwy 1 N, Vass NC 28394!

Wellness Appointment Request Form