Appointment Request

ADAIR COUNTY ANIMAL HOSPITAL & LASER SURGERY CENTER

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Appointment Request

If this is an emergency, please call the office immediately! Otherwise, kindly allow 24-48 hours to process your request.

* Indicates required field

OWNER OR CO-OWNER: *

First

Last

Additionally, if you are a new client, please print and fill out the New Client Welcome Sheet and bring it with you to the appointment.

ADDRESS: *

Line 1

Line 2

City

State

Zip Code

Country

EMAIL: *

Type "N/A" if you do not have one.

PHONE NUMBER *

TYPE: *

Cell Home Work

Contact me about this appointment request via: *

Phone Call Text Message Email

CLIENT STATUS: *

Existing Client New Client

If you are a new client, please print and fill out the New Client Welcome Sheet (see Forms tab.) Also, bring all previous medical and or vaccination records with you to your pet's appointment so we may better tailor their healthcare.

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

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PET'S NAME: *

ANIMAL SPECIES: *

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

Other type of animal: *

GENDER: *

Female Spayed Female Male Neutered Male

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

VACCINATIONS: *

5-way or DHP-Pv+L4 (basic canine vaccine) Lepto bi-annual only (canine) Bordetella or kennel cough (canine) Lyme (canine) Influenza (Canine) Rabies- 1 Year FVRCP (basic feline vaccine) Feline Leukemia- "FELV"

An exam by the veterinarian is required for most vaccinations to ensure the patient is healthy enough to receive them.

LAB WORK: *

Fecal- intestinal parasite screening Canine Heartworm Test-- 4DX Plus (heartworm + 3 tick-borne diseases) Feline Heartworm Test-- 3 in 1 (Leukemia, Immunodeficiency Virus (FIV), and heartworm) General Blood Work: Complete Blood Count, Electrolytes, and Chemistry Complete Blood Count only Senior Blood Work Screening Diabetic Blood Work Urinalysis and Sediment Ultrasound Digital X-Ray Other

ANESTHETIC PROCEDURE: *

Teeth Cleaning & Digital Dental X-Ray Canine Neuter - Laser Canine Spay - Laser Feline Neuter (Non-Laser due to being a minimally invasive procedure.) Feline Spay - Laser Feline Laser Declaw (Front Only) Feline Laser Declaw (All Paws)

Monday- Friday only. Pets must arrive to the hospital between 8am and 8:30am to allow ample time for any pre-surgical blood screenings and surgery preparations. Please fill out registration/admit/consent forms prior to arrival and bring with you to expedite their drop off. Due to Kentucky State law requiring an up-to-date rabies vaccination, proof of a rabies vaccination given by a licensed veterinarian is required or one will administered for you.

MAINTENANCE THERAPY: *

L.A.S.E.R. Therapy (Light Amplification by Stimulated Emission of Radiation) Massage Therapy Adequan Injection Allergy Injection (Hyposensitization) Behavior Training Weight Check

DAY SPA SERVICES: *

Groom Package: includes haircut, blow out (force hair dryer,) regular pedicure (nail trim,) and anal gland expression. Bath (regular kennel dryer- slow dry) Bath and Blow out (with force dryer) 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

Proof of required vaccinations required.

Other type of service NOT listed above: *

Please see Boarding page to request a reservation.

COMMENT: *

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Adair County Animal Hospital & lASER sURGERY cENTER

(Main Office) 270-384-6113
2004 Campbellsville Road, Columbia, KY 42728

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About Us
Services
Wellness Plans
Contact Us
Forms
Pet Parent Resources
Apply
Training