SPONSORED Wellness Appointment Request Form

SPONSORED Wellness Appointment Request Form

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

This application is for a FREE WELLNESS EXAM. Preventative and wellness care is essential for your pet! It helps pets live longer, healthier lives by preventing serious illnesses through vaccinations,managing parasites, and so much more! Applications are limited to the FIRST 20 submissions. All appointments require a $25.00 deposit for your wellness apppointment. This deposit is REFUNDABLE if our deposit policy guidelines are followed, or may be used towards any services outside of your FREE exam you may request. Please note that ALL pets MUST BE CURRENT ON THEIR RABIES VACCINE AND PROVIDE A CERTIFICATE ,OR RECIEVE A RABIES VACCINE. This offer is limited to TWO FREE EXAMS per household. Please complete an application for each individual Pet. 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
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. A Rabies vaccine or certificate is required for all appointments.

Cancelof
If you are requesting additional services outside of your Pets wellness exam, please check which services you would like at this appointment. Services requested outside of your exam are the financial responsibility of the owner.

Nail Trim ($25.00)Ear Cleaning ($20.00)Anal Gland Expression ($25.00)Microchip ($30.00 - includes lifetime registration)Rabies Vaccine ($15.00 - REQUIRED IF CURRENT CERTIFICATE IS NOT PROVIDED)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 and type of dewormer)Bravecto-Flea/Tick Prevention ($60.00 for a 3 month supply)Provecta Topical Flea/Tick Prevention ($8.00-$10.00 for single month dose)ProVecta Topical Flea/Tick Prevention ($25.00-$30.00 for a 4 month supply)
Please select your preferred appointment date:*

2/26/2026 (Thursday)3/12/2026 (Thursday)I do NOT have a preferred date
Do you have any additional information on your Pet to provide?

My Products

Appointment Deposit Product Image

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
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