Appointment Request

CLIENT STATUS: *

Existing Client New Client

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

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!

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 Fetch-A-Pet (House Call) Euthanasia

DAY SPA SERVICES: *

Groom/Bath Package includes: bath, basic haircut (if needed,) blow out (force hair dryer,) outer ear cleaning, and regular pedicure (nail trim) Brush Teeth with Enzymatic Pet Toothpaste Deluxe Pedicure (nail trim with a smooth, buffed finish) Ear Canal Cleaning Ear Canal Hair Plucking Express Anal Glands Sanitary Trim

Other type of service NOT listed above: *

Appointment Request

Adair County Animal Hospital & lASER sURGERY cENTER

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