Admission Form

For Dogs & Cats: If you are filling out an Admission Form, a copy of your most recent rabies vaccine is required (only if you are not purchasing the rabies vaccines and your pet is over 12 weeks old). If you request the booster vaccines, a copy of recent vaccination records is required.

Step 1 of 4 - Your Information

Note: One of the adult individuals listed below MUST be present when pet is admitted and released unless prior arrangements have been made.
Your Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
County of Residence*
Mobile Phone*
Home Phone
Work Phone
Number we can reach you at ON THE DAY of appointment at ALL TIMES?*
Other Phone*
Email*
Do you have an alternate contact?*
- Yes
- No
Alternate Contact Name*
First Last
Alternate Contact Mobile Phone*
Does this person have the ability to make medical decisions or are they simply an emergency contact?*
- Emergency contact only
- Can make medical decisions
- Both, emergency contact and can make medical decisions

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Admission Form

Step 1 of 4 - Your Information

General Information About Your Pet

Your Pet's History

AKC Reunite Microchip Registration

Communication Preferences

Dogs Wellness Clinic Services

Dogs Surgeries

Cats Wellness Clinic Services

Cats Surgeries

Rabbits Surgeries

Additional Information

Request an Appointment Appointment

Getting Started Get Started

Admission Form Admission Form