Telephone Consultation Request

If you would like to request an telephone consultation appointment, please complete the information below. Once received, Dr. Smith will email you (usually by the end of the business day) with any questions and a suggested date/time, along with a link to enter payment information to hold that time.

If you are ready to set a time for a euthanasia appointment instead, please use our new scheduling App to pick a convenient time and provide all the necessary information.

Feel free to contact us via phone or email if you have any questions or difficulty completing the form. If this is an urgent matter, Please call or text, as well.

Name

First Name

Last Name

Phone - Primary

(###)

###

####

Phone - Alternate

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pet's Name

Pet's Sex

Female (spayed)

Female (intact)

Male (neutered)

Male (intact)

Pet's Age

Pet's Weight

(in pounds)

Pet's Breed

Pet Color

Pet's Main Ailment/Condition

Pet's Regular Veterinary Hospital(s)

Appointment Info

What days and/or times would work best for an appointment? (If already scheduled, please indicate date/time)

How did you hear about us?

Questions, Comments, or Feedback