Pet's Name *

Name *

First

Last

Car Description *

To help our staff find you in the parking lot when you get here.

Please select all that apply. *

I have been experiencing cold/flu symptoms.
I have traveled out of the country in the last 30 days.
I have been exposed to COVID-19 or someone with it.
None of the above
Other

If other, please explain:

Phone number to be reached at for your visit (cell phone): *

May we add this number to your file ?

This number is already in my file.
Yes
No

May we use this number for text messages?

Yes
No

It is imperative that we be able to reach you in a timely manner while your pet is in the building with us. Please have your cell phone listed above available and be free to talk. If you need to leave your car, leave the parking lot, or will be otherwise occupied while your pet is here, please ask us about a drop-off appointment.

The reason for your visit: *

If other, please explain: *

Has your pet been eating and drinking like normal? (If no, please explain and state when you noticed a change.)

Has your pet experienced any diarrhea or vomiting? (If yes, please explain and state when it began.)

While my pet is here I would like the following done (if possible). Select all that apply below:

Nail Trim
Anal Gland Expression
Other

If other, please explain: *

Is there anything we should keep in mind when working with your pet? Examples: Bites, doesn't like men, deaf, blind, dog aggressive, etc.

Do you have any other questions or concerns regarding your pet?

Do you need any medication refills?

Heartworm Prevention
Flea/Tick Prevention
Other

If other, please explain: *

Are we able to email you a copy of your invoice when your visit is complete?

Yes, I will enter my email below.
No, I prefer a paper copy.

Email *

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