Veterinary Services Request Form

Veterinary Services Request Form

Please fill out the form to book your appointment.
Client Information
Full Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Pet Information
Pet's Name
Type of Pet

Other
Breed
Weight
Age
Gender
Medical History

Please provide any relevant medical history for your pet.
Vaccination Record

Cancelof
Medical Conditions
Reason for Visit
Service Needed

Other
Preferred Appointment Day
Additional Comments
I agree to drop off my pet for services and pick up same day (if drop off is required)
Slumdog makes every reasonable effort to ensure the health and safety of animals. However, Slumdog Rescue shall not be held liable, financially or otherwise, for any illness, injury, medical emergency, or death that occurs to the animal while in the custody of an independent, third-party veterinary clinic. By entrusting the animal to veterinary professionals, the adopter/foster assumes all risks inherent to veterinary procedures, including but not limited to anesthesia complications, unforeseen reactions to medications, or sudden health crises. The Slumdog Rescue is released from any and all liability in the absence of gross negligence or intentional misconduct.
Surgeries and services are scheduled with our rescue partners, one clinic is in Clinton, one in Halls and another in Bearden Area/Knoxville.
Signature
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Veterinary Services Request Form

Client Information

Pet Information

Medical History