Thank you for your interest in Vet Connection.We would love the opportunity to work with you and your pet(s). Please allow us to get to know you and your goals for your pet’s care by filling out the form below.Initial Wellness Visit costs, on average, range from $250-$350 per pet. Name * First Name Last Name Phone * (###) ### #### Email * This will enroll you in Vet Connection's email communications. Physical Address * Address 1 Address 2 City State/Province Zip/Postal Code Country My pet's name: * One pet per form, please. My pet is a: * Dog Cat Other My pet's age or date of birth: * Estimated age if exact age is not known. My pet's breed: * My pet's color: * My pet is: * Female, spayed Female, intact Male, neutered Male, intact My pet's most recent or approximate weight: * My goals for this visit include: * Check any/all that apply. If you are looking for in-home euthanasia services, please select the "End of Life Care" menu at the top of this page and fill out the "In-Home Euthanasia" form. General wellness check or annual vet exam Injury or illness Quality of life exam and consultation Other If "other" selected above, please elaborate: I am interested in: * Conventional care Integrative care Holistic care I'm not sure Please elaborate on any current issues, illnesses or chronic diseases: * If none, please type "none". Is your pet on any medications or supplements (including heartworm or flea/tick prevention)? If so, please list below: * If none, please type "none". What is your pet's current diet (brand/type/formula, amount and any additional food/treats)? * How soon are you looking to schedule your in-home visit? * As soon as possible/urgent Within 1 week Within 2 weeks This month Already scheduled Please select the days of the week and time of day that work best for your schedule: * Availability is not guaranteed, but we will do our best to accommodate any scheduling constraints you may have. Select all that apply. Monday Tuesday Wednesday Thursday Friday Morning (arrival 9am-12pm) Afternoon (arrival 12pm-3pm) If you do have any scheduling constraints we should be aware of, please let us know below: * If none, please type "none". What questions or concerns do you have for your pet's visit? * If none, please type "none". We typically recommend using Chewy as an online pharmacy for your pet's prescriptions. However, there may be times when a local pharmacy is needed. What is your preferred pharmacy for picking up medications? * If you already have an account with Chewy.com, please let us know which email address you use in case we need to put in any online prescriptions for your pet. * How did you hear about Vet Connection? * If you were referred by another client, please leave their name so that we may thank them. Please provide the name of your most recent vet clinic: * Please provide any of your pet's previous vaccine or relevant medical history: * I will email my pet's records to info@yourvetconnection.com I do not have previous records for my pet Is there anything else that you would like us to know about your pet? Thank you!Please call, text or email if we have no already been in touch.I look forward to caring for your pet.—Becca830-777-6500info@yourvetconnection.com
