Appointment Request

OWNER OR CO-OWNER: *

First

Last

PRIMARY PHONE NUMBER *

CLIENT STATUS: *

Existing Client New Client

NEW CLIENTS ONLY: You'll receive $10 off your first exam as a welcome gift! Did a friend recommend us? If so, we'll apply a $10 new client referral credit to their account as a thank you! Please enter your referring friend's name here: *

First

Last

ANIMAL SPECIES: *

Cat Dog Other (Please specify in the box below.)

OTHER SPECIFIC ANIMAL SPECIES: *

Does this pet have an ACAH Wellness Plan? *

No No, but I am interested. Yes! I love the Wellness Plan!

PREFERRED VETERINARIAN: *

Dr. Shantila Rexroat Dr. Terri Pettyjohn No Preference

DATE(S) OF REQUEST (MM/DD/YYYY): *

MON. - FRI. APPOINTMENT TIME REQUESTED: *

Morning Preferred Afternoon Preferred Anytime between 8:30 am & 4:00 pm

SATURDAY APPOINTMENT TIME REQUESTED: *

Anytime between 8:30 am & 11:30 am Early Morning Preferred Late Morning Preferred

Needing an appointment for:
(Please select all services requested during one visit.)

AN EXAM: *

Puppy/ Kitten Wellness Exam or Booster Exam (under 6 months old) Adult Annual Wellness/ Bi-Annual Wellness Exam (over 6 months- 7 years old) Senior Annual/ Bi-Annual Wellness Exam (over 7 years old) Adult or Senior Booster Vaccination Exam (for previous vaccinations given by us within the last 3 weeks) Illness/ Injury Exam Recheck a previous issue (seen by us within the last 4 weeks) Post-Surgical Recheck House Call (Small Animal) Euthanasia

DAY SPA SERVICES: *

Groom Package includes: bath, haircut (if needed,) blow out (force hair dryer,) and regular pedicure (nail trim) Sanitary Trim Regular Pedicure (regular nail trim) Deluxe Pedicure (nail trim with a smooth, buffed finish) Express Anal Glands Brush Teeth with Enzymatic Pet Toothpaste

Other type of service NOT listed above: *

Appointment Request

Adair County Animal Hospital & lASER sURGERY cENTER

Pet Owner Resources