|Do you have a new patient appointment already scheduled?|
If so, please enter the date and time below.
Note: entering a date and time below will not schedule an appointment for you. You must call our office at 901-682-5681 to schedule.
|E-Mail Address (required) : |
|Preferred contact method (required)|
|May we text you for reminder purposes? (required)|
|WHERE were your pets last vaccinated? (required)|
|Pet's name: (required)|
|Pet's DOB/Age: (required)|
|Is your pet microchipped? (required)|
|I understand that payment is REQUIRED at the time services are rendered. We accept cash, VISA, Mastercard, Discover, and Care Credit. We do not accept checks.|
|I authorize Doctors to run laboratory test, take radiographs, and/or perform surgery in attempt to arrive at a proper diagnoses and to affect the best possible treatment.|
|DUE TO STATE LAW AND INSURANCE REQUIREMENTS, ALL DOGS &CATS MUST BE CURRENT ON RABIES VACCINATION. Vaccination can and will be updated at the time of your appointment if not current.|
|I agree to reimburse us the fees of any collection agency, which may be based on a percentage at maximum of 32% of the debt, and all costs, expenses, including reasonable attorney's fees, we incur in such collection efforts.|
|In the event payment is not made in 30 days, I further agree to pay 1.5% per month on the unpaid balance with minimum of $3.00 per month billing charge.|
|I am at least 18 years of age.|
|By checking yes and submitting this form, I agree that all information above is correct to the best of my abilities. I further agree to all terms and conditions listed on this form. (required)|
We will require photo identification at your first appointment.
For example: driver's license, passport, etc.