New Companion Crossing Appointment Request

Companion Crossing

Appointment Request
***PLEASE NOTE: Thank you for understanding that, as I take a brief pause to honor the passing of my own cat Lily, my availability will be limited to families I have previously assisted and I am unable to assist families new to my service at this time. Please accept my appreciation for allowing me the same compassion I strive to offer every family. 🐾Dr.Rebecca
Please complete the form below to request an appointment. Dr. McClellan will contact you to discuss availability and confirm an appointment date and time.
We understand the urgency of your family’s needs and Dr. McClellan will follow up with you at her earliest opportunity. Thank you for understanding that same-day visits are very limited in availability. If you submit this form after 5pm, Dr. McClellan will contact you the following morning after 8am. You may also contact us by phone/text at 256-808-5205 before 6pm. If you feel your pet is experiencing an emergency, please contact your nearest emergency clinic.*

I have read and understand.
Please Select the Service Requested*

TeleAdvice Quality of Life Phone ConsultationIn-Home Euthanasia VisitEuthanasia at our Comfort Center
Your Name*

FirstLast
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
****Please provide if you would like a confirmation copy of this form.
Have we assisted your family before?*

YesWe are new to your service.
Pet’s name*
Species*

DogCat
Pet’s approximate age*
Pet’s approximate weight*
Breed*
Has your pet been seen by a veterinarian within the past six months? If so, please provide the clinic name.
Please tell us about your pet and what brought you to seek our services.
Please share a few preferred dates and times for our Visit/Consultation. Thank you for understanding that requested times may not be available.
I prefer to be contacted by*

Text message(This is often the fastest way to receive a response)Phone callEmail(Please be sure to check your SPAM folder for responses)
Should be Empty: