JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Haines Trail Breaker Veterinary Services - Appointment Request Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Mailing Address
*
Your answer
Pet Name
*
Your answer
Species
*
Dog
Cat
Other
Breed
*
Your answer
Pet's Age
*
Your answer
Pet's Sex
*
Male Intact
Female Intact
Male Neutered
Female Spayed
Service needed?
*
Spay
Neuter
Dental Cleaning - see our dental flier for Dental Levels and estimates
Mass removal - this can vary greatly depending on the mass, we may ask for a video chat with our vet nurse the week prior to plan and give you a better estimate
Annual exam and vaccines
Problem Exam: skin or ears
Problem exam: pain or stiffness/lameness
Problem Exam: medical condition/prescription mgmt
Labwork (blood values, urinalysis, fecal analysis, biopsies)
Acupuncture - regional or a full consultation
Medical Shave Down - this means we sedate the animal in order to shave them all the way down and possible also a medicated bath.. This is necessary for animals with severe matting, soiling, and/or skin infections. If they will not tolerate grooming while awake this is a good option. It requires an exam and supervision by a veterinarian, but it can be very important for the animal's health and the humans in their household.
Other:
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
