* Required fields

Requested Date (from next available surgery dates listed on website)*

Second Choice Date (from next available surgery dates listed on website)*

First Name*

Last Name*

Email*

Phone Number* (cell preferred, XXX-XXX-XXXX)

Can you send/receive texts using this number?*
Yes
No

Street Address*

City*
State*
Zip*

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Dog's Name*

Male or Female*
Male
Female
Can't Tell

Dog's Age*

Dog Breed & Description* (breed, color, pattern)

Dog's Approximate Weight*

(Dogs must weigh less than 20 lbs, and fit into a small or medium-sized carrier)
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Date of Last DHPP Vaccination*

(It is recommended that all dogs have at least one DHPP vaccination to protect against common upper-respiratory diseases.)

Date of Last Rabies Vaccination*

Has your dog been tested for Heartworm within the last year?*
Yes
No

Do You Need to Rent a Hard-Sided, Plastic Carrier? ($10 to rent)
(A hard-sided, plastic carrier is required for the surgery day – soft luggage bags or cardboard are not sufficient. If you don’t have one, you can rent one from us. Your dog must be able to fit in a small or medium sized carrier; we cannot handle large carriers.)
Yes
No

Want DHPP vaccination? ($10)
Yes
No

Want Rabies vaccination? ($10; must be 4 months old)
Yes
No

Want Microchip? ($15, includes lifetime registration)
Yes
No

Want Heartworm test? ($25)
Yes
No

How did you hear about us?

If you have more than one dog, please hit Send, and then fill out the form again for each dog. The time, date, and location of the required registration appointment will be in your confirmation e-mail.

It has come to our attention that our emails sometimes end up in people's spam folders. As soon as you click the Send button, an automated response email will be sent to the email address you submitted above. If you do not find this email within 5 minutes, please check your spam folder.

Be advised that the follow-up emails, including the most important one one asking you to confirm scheduled dates, will likely also end up in your spam folder. We require a response to this email to finalize and hold your appointment. Dates are assigned "first-come, first serve," and we are scheduling several weeks out. Please check your spam folder!