EmailMe Form - Dog Pre-Registration Questionairre

Dog Pre-Registration Questionairre

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*** PRICING is by weight ***

01-45lb Male $58 Female $68
46-55lb Male $70 Female $80
56 & up Male $80 Female $90

Completing this questionnaire is NOT a guaranteed appointment for the clinic! Space is limited and its booked on a first come, first served basis. Applicants will be confirmed in the order in which these applications are received. You will be called back and given a confirmation check in time. Once full you will be placed on a wait list for any cancellations.

Name *
First Last
Phone *
### - ### - ####
Best Time to call *
Address *
City, State *
Zip *
Email Address *
PET INFORMATION
Pets Name *
Age *
Breed *
How much does your dog weigh? *
Do you have a crate you can leave with your dog?
Please note:
Surgery includes rabies vaccination and vaccine booster. You may decline the routine vaccinations at check in, but RABIES IS MANDATORY and will be given unless you provide a valid rabies certificate indicating current vaccination. (Tags are not acceptable proof). PLEASE BRING THE CERTIFICATE WITH YOU! We do not have means to have it faxed to us by your vet.
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Neuter (Male), DA2PPV, and Rabies ($58/$70/$80)
Spay (Female), DA2PPV, and Rabies ($68/$80/$90)
Heartworm Test ($25)
Bordetella Vaccine ($10)
Microchip ($25)
Extra Pain Meds ($10)
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PET INFORMATION

Please note: