Appointment Request - ADAIR COUNTY ANIMAL HOSPITAL & LASER SURGERY CENTER

ADAIR COUNTY ANIMAL HOSPITAL & LASER SURGERY CENTER

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Appointment Request

If this is a life-threatening emergency, please call the office immediately! Otherwise, kindly allow one business day 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.

PRIMARY PHONE NUMBER *

The previous primary phone number listed is a: *

Cell Phone Home Phone

HOME ADDRESS: *

Line 1

Line 2

City

State

Zip Code

Country

EMAIL: *

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

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: Did a current client of ours recommend us to you? If so, we'll apply a $10 credit to their account as a thank you! (Plus you'll get a $10 credit as well!) Please enter your referring friend's name here: *

First

Last

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PET'S NAME: *

GENDER: *

Female Spayed Female Male Neutered Male

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): *

Our spay & neuter surgeries (except feline neuters) are scheduled on Monday - Wednesday only.

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.

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

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 17 or NSAID 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.

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

Proof of required vaccinations required. Grooming cost is based on coat type/length & pet weight.

Other type of service NOT listed above: *

Please see Boarding page to request a reservation.

Other questions or concerns: *

Help us! How did you hear about us? (Select ALL that apply.) *

DVM Referral Friend / Family Member ACAH & LSC Staff Member Internet Search Drove by our location Facebook Instagram YouTube Billboard Ad Other

SUBMIT REQUEST

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
Contact Us
Forms
Wellness Plans
Pet Parent Resources
Apply
Training