Clinic Appointment Request Form

If you would like to schedule an appointment in our clinic, please fill out the following form. Please note that this is a request and you will be contacted to confirm the appointment. Once the appointment is confirmed, all appointments must be canceled 24hrs prior to the scheduled check-in time. Late cancellations will result in a $15.00 fee that must be paid prior to rescheduling or receiving future services. Failure to cancel and then not arrive for your appointment will result in a NO-SHOW Fee, which will require that a $25.00 fee is paid prior to rescheduling, or receiving future services.

Appointment Request Form

Reason for Appointment*
Are you a current VBSPCA clinic client?*
- Yes
- No
Animal Name
Species*
Breed
Sex
Neutered
Age
Weight
Current on Vaccinations?
Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Information
I Understand and Agree*
I understand that the clinic will contact me during normal business hours via the phone number I provided to schedule my appointment, and that my appointment is not confirmed until I have been notified by a staff member. I understand I can not use this form for a veterinary emergency situation, and that all emergencies must be scheduled in person or via phone. I understand that payment is due at the time that services are rendered. I am responsible for contacting the clinic at least 24 hours in advance (via email or phone) to cancel my appointment. Failure to provide 24 hour advance notice of cancellation will result in a $20 missed appointment fee and possible
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Clinic Appointment Request Form

Appointment Request Form

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