Request An Appointment

Request an Appointment

If this is a pet medical emergency, please directly call us or drive to your nearest veterinary Hospital! Please do not complete this request form. Please note, this is a request, not a confirmed appointment. A client service coordinator will be in touch within 48-72 hours to further discuss the details of your appointment request.

Have you been to Advanced Veterinary Specialists before?*
- Yes
- No
Department*
Name*
First Last
Alternate Name

A different name the record could be under.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone Number*
Primary contact date of birth*
MM slash DD slash YYYY
Secondary Contact
First Last
Secondary Contact Phone
Pet's Name*
Pet's Sex*
- Male
- Female
Is the Pet*
- Spayed
- Neutered
- N/A
Pet's date of birth*
MM slash DD slash YYYY
Pet's Breed*
Pet's Color*
Has your pet ever bitten anyone?*
- Yes
- No
Primary Vet Hospital*
Reason for appointment (max 120 characters)*
How Did You Hear About Us?*
Phone
This field is for validation purposes and should be left unchanged.