Current Client AppointmentNote: We prefer that clients call to book appointments as emails are not always checked promptly. Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Pet's Name*Age: Years, MonthsType of PetCanineFelineAvianExoticOtherBreedSex*MaleFemaleNeutered/SpayedNeuteredSpayedAre your pets vaccines current?YesNoDo you have pets medical records?YesNoMedical records at another veterinary Practice?YesNoName of Former Veterinary PracticeMay we request a transfer of records?YesNoWould you like us to call you for your appointmentYesNoReasons or conditions that prompted your visit?Special requests or conditions?Please list any additional pets herePlease Read I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Dr. Calland - Veterinary Consulting Service and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Dr. Calland - Veterinary Consulting Service 's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.I have read this statement and -*I AgreeI DisagreeNameThis field is for validation purposes and should be left unchanged.