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?*
Services coming soon: Cardiology, Dentistry & Oral Surgery, and Neurology.
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.
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?*
How did you hear about us? Please select one option below.*

EmployeeFacebook/Social MediaFamily/FriendInternet SearchLocal EventPrint AdvertisementReferring VeterinarianWalked/Drove PastWord of MouthOther
Please enter two dates below that you're available for an appointment:
First Requested Date:*

MonthDayYear
What time works best for you? (select all that apply)

Anytime8a-10a10a-12p12p-2p2p-4:30p
Second Requested Date:*

MonthDayYear
What time works best for you? (select all that apply)

Anytime8a-10a10a-12p12p-2p2p-4:30p
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 upload your pet's records below.

Cancelof
Please list the city and state the practice is located in?
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

Please enter two dates below that you're available for an appointment:

Pet's Referring or Primary Veterinarian