Specialty Appointment Request Form

Specialty Appointment Request Form

Please fill out the form below to request an appointment with one of our Specialty departments. A member of our team will get back to you within 48 business hours. If this is an emergency, please call the nearest Veterinary emergency hospital for assistance.
To schedule an appointment with our Primary Care department, please click here: Primary Care Appointment Request Form
Which service are you requesting an appointment for?
Other services coming soon!
Are you a new or existing client?
Client Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Number and Street Name

Apt/Unit Number (If this does not apply, enter "N/A")

CityState / Province

Postal / Zip Code
Pet's Name:
What kind of pet do you have?
(i.e., Cat, Dog, Bird, Lizard, Rabbit, etc.)
Breed:
Color:
Age or Date of Birth:
Sex:
Is she/he spayed or neutered?
Additional Pet(s):
Pet's Name (second pet):
What kind of pet do you have?
(i.e., Cat, Dog, Bird, Lizard, Rabbit, etc.)
Breed:
Color:
Age or Date of Birth:
Sex:
Is she/he spayed or neutered?
Pet's Name (third pet):
What kind of pet do you have?
(i.e., Cat, Dog, Bird, Lizard, Rabbit, etc.)
Breed:
Color:
Age or Date of Birth:
Sex:
Is she/he spayed or neutered?
How did you hear about us? Please select one option below.

Other
Please enter your availability for an appointment below:
What day works best for you? (select all that apply)
What time works best for you? (select all that apply)
Please explain the reason for this appointment:
Please be as specific as possible and enter any additional details or requests you have.
Pet's Referring or Primary Veterinarian
Were you referred to us by another veterinarian?
What is the name of the veterinary clinic that referred your pet?
If your pet was not referred, enter "N/A".
Please list the city and state the practice is located in?
What is the name of your pet's primary veterinary clinic
If your pet does not have a primary veterinarian, enter "N/A".
Please list the city and state the practice is located in?
Please upload your pet's records below.

Cancelof
A member of our team will reach out to schedule your pet's appointment. What is your preferred contact method?
I fully understand that this form is for non-urgent appointment requests only, and I confirm that my pet is not in need of urgent or emergent medical care. I understand that a reply to this appointment request can take up to 48 business hrs.
***If your pet is experiencing a medical emergency, please contact the nearest veterinary emergency hospital immediately***
Should be Empty:

Specialty Appointment Request Form

Additional Pet(s):

Please enter your availability for an appointment below:

Pet's Referring or Primary Veterinarian