Use this form to schedule a checkup, follow-up exam, immunizations, or any non-emergency visit. We will try our best to schedule your appointment at the date and time you provide. We will notify you of your appointment via e-mail. New patients will receive a request confimation e-mail. See details below for new patients. You should receive an appointment e-mail within 24-36 hours. If not, please give us a call.

New Patients
Please check the New Patient box to receive New Patient forms attached to your request confirmation e-mail. We will e-mail you of your actual appointment date and time. If possible, fill in the Word document and return it to us as an attachment. This will allow you to better attend your pet while waiting for an appointment. If you forget to e-mail or bring the form with you, please allow 15 minutes prior to your check-in to fill out the form.

Type of Request

Select the type of request:

Owner Information

Owner Name		Co-Owner Name
First		First
Last		Last
Client #

Address
Address		City
State		Zip Code
Telephone		e-Mail
What's This?

Pet Information

Pet Name(s)
First Doctor Preference		Second Doctor Preference
Please indicate the reason for your visit and add any necessary notes:

Check here if new patient

Request Date and Time

Provide desired appointment date:	If unavailable, provide a backup date:
Provide desired appointment time:	Provide a backup appointment time: