Appointment Scheduling Form

APPOINTMENT SCHEDULING FORM

If you have a pet emergency, please call us at (541) 758-4509 so we may address your concerns promptly. If it is before or after our business hours, please contact Willamette Emergency clinic at (541) 753-5750.

*E-mails regarding appointments will be answered as soon as possible. Please
call our office at (541) 758-4509 if you would like your pet to be seen today. Thank you!

Client Name:
Client Email:
Patient Name :
Client Phone Number:
Have we seen your pet before:	Yes No
Reason for Appointment:
If your pet is ill, when was the issue noted:
What dates and times suit your shedule:

Are there any products (food, prescriptions, supplements) you wish to pick up at the time of your visit?


If your pet is new to us, who is his/ her previous veterinarian, and may we contact them to request records?
Yes No	Previous Veterinarian:	Phone Number of Previous Vet: