Contact Form

Contact Information

Client Name

Spouse/Other (Optional)

Street Address

State

City

Zip Code

Cell Number

Pet Information

Pet Name

Microchip Number (Optional)

Birth Date

Species

Breed

Color

Sex

Pet Medical History

Prior Illnesses

Prior Surgeries

Has your pet been seen by another doctor (Y/N)? If so, what was the name and phone number of the facility so we may contact them?

Date Last Vaccinated

Do you have other pets?

Rescheduling Policy - Signature Required

If you need to reschedule your scheduled appointment, call at least 24 hours in advance. Any appointments cancelled day of will be considered No Call No Show. 3 No call No shows will result in deposits being required when booking an appointment in the future. All situations can be considered by the office manager and potentially deemed excused, as we understand emergencies happen.

State of Ohio Prescription Regulations - Signature Required

By the State of Ohio, we are required to have a yearly physical exam on your pet to prescribe any medications. If the exam is not current, we will unfortunately have to deny any medication requests until an exam is performed.

No Tolerance Policy - Signature Required

We have a no tolerance policy regarding violence and verbal abuse towards our staff. This behavior could resort in termination as a client from clinic. If you have any questions, please talk with our office manager.

Late Policy - Signature Required

If you are more than 15 minutes late for your scheduled appointment, you will have to reschedule.