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Curbside Appointment Form
Thank you for being understanding about our new curbside appointment policy. This is to be completed and submitted AFTER speaking with a receptionist to schedule your appointment at our clinic. Please complete this form anytime prior to your appointment. When you arrive for your appointment, please give us a call at 517-676-5422. While your pet is here for their appointment, we will need you to remain in our parking lot. If needed, we will give you more information about the appointment process when you arrive.
Owner's Name
Name
*
First
Last
Best Phone Number to Reach You At:
*
Would you like this phone number updated as the primary phone in your account?
*
Yes
No
Date & Time of Appointment:
*
Vehicle Make/Model & Color you will be driving:
*
Pet Information
Pet's Name
*
Reason for Visit:
*
Is this an annual wellness visit?
No
Yes
If no, when was your pet last normal?
Is your pet experiencing any of these symptoms?
Is there a change in your pet's eating or appetite?
Yes
No
If pet isn't eating normally, please describe:
Is your pet vomiting?
Yes
No
If your pet is vomiting, please describe:
Is your pet having diarrhea or hard stools?
Yes
No
If your pet is having diarrhea or hard stools, please describe:
Are there changes in your pet's urination?
Yes
No
If your pet is not urinating normally, please describe:
Is your pet sneezing or coughing?
Yes
No
If your pet is sneezing or coughing, please describe:
Is your pet acting tired?
Yes
No
If your pet is acting tired, please describe:
Is your pet acting lame?
Yes
No
If your pet is acting lame, please describe:
Has your pet ever had a vaccine reaction?
Yes
No
If yes, please describe the reaction & when it happened:
What are you currently feeding your pet and how much are you feeding?
Please list any medications that your pet takes. Include heartworm prevention, and flea and tick prevention and any over the counter medications your pet takes:
Do you need refills of any medications? If yes, please list them below, include heartworm, flea and tick prevention and how many months of each you need.
Is there anything else you are concerned about? Please give us as much detail as you can:
We appreciate payment when services are rendered. For your convenience, we accept Mastercard, Visa, Discover, American Express, Care Credit, and Cash. Which method will you be using?
*
Cash
Credit/Debit Card
Care Credit
If you are concerned about us handling your method of payment, how would you like us to go about payment?
Clients
Make an Appointment
Telehealth Appointment Request
New Client Registration Form
Medication Request Form
About Us
Contact Us
Our Team
Patient Spotlight
Crash
Clinic Information
Pet Services
Medical Services
Surgical Services
Wellness and Vaccination Programs
Anesthesia and Patient Monitoring
Exotic Pet Medicine and Surgery
Preventive Services
Nutritional Counseling
Additional Services
End of Life Services
All Services
Pet Health
Pet Health Library
Pet Health Checker
How-To Videos
News
Pet Insurance
Product Recalls
Pet Food Recalls
Links
Contact Us
Online Store
facebook
instagram
