New Client/Pet Appointment Request

Wallace Animal Hospital

483 Stallings Road
Teachey, NC 28464

(910)285-5454

wallaceanimalhospital.com

New Client Appointment

In our ongoing effort to make scheduling an appointment as convenient and easy as possible, you can now complete the new client/pet form online. Please be sure to fill in all the requested information. Additional pets can be added in clinic after your initial visit.

We will notify you via text, email or phone our availability for appointments. A deposit will be required to secure your initial visit. The deposit will go towards your first visit. In the event of a no show, the deposit is forfeited. We also require a 24 business hour notice of a reschedule or cancellation to avoid a missed appointment fee. Emergency situation are taking into consideration. Deposits can be made via text through secure site, by phone or in person.

New Client/Pet Appointment

Name (required)

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

Phone (required)
Phone Type	Phone Number (required)

Phone
Phone Type	Phone Number

E-Mail Address (required) :

If your pet is having an urgent medical problem, please call us to make an appointment right away!

Pet Information

Pet's Name (required)

Pet's Species: Cat or Dog (required)

Breed (required)

Sex: Male or Female (required)

Has your pet been altered? (Spayed/Neutered) Yes or No

Age: Birthdate, Years, Months (required)

Color (required)

Is your pet aggressive? Yes or No (required)

Reason for scheduling appointment? (required)

Is your pet up to date on vaccines? Yes or No (required)

Can we contact your previous vet for records? Yes, No, Don't have one. (required)

Previous Vet(s) if applicable (required)

If you have a copy of your pet's records, please email them to wallaceanimalhospital@centurylink.net. Please include your pet's name and your last name in the subject field.

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Wallace Animal Hospital
483 Stallings Road
Teachey, NC 28464
(910)285-5454

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