PRIORITY
Please choose one of the following:

Limited Followup - Nonurgent: $65 USD, $68.25 CDN incl GST
Limited Followup - Urgent: $80 USD, $84 CDN incl GST
Limited Followup - Emergency: $95 USD, $99.75 CDN incl GST
Basic - Non-Urgent: $95 USD, $99.75 CDN incl GST
Basic - Urgent: $110 USD, $115.50 CDN incl GST
Basic - Emergency: $125 USD, $131.25 CDN incl GST
Full- Non-Urgent: $125 USD, $131.25 CDN incl GST
Full - Urgent: $140 USD, $147.00 CDN incl GST
Full - Emergency: $155 USD, $162.75 CDN incl GST
Extensive - Non-Urgent: $175 USD, $183.75 CDN incl GST

CONTACT INFORMATION
Please fill out ALL the fields below

First name:

Last Name:

Email address:

Telephone number:

Street address/PO Box no:

City:

State/Province:

Zip/Postal Code:

Country:

INFORMATION ABOUT THE ANIMAL
Please fill out ALL the fields below

What kind of animal is it?

Your animal friend's name:

Your animal friend's age:

Your animal friend's sex:

How long has your animal friend been with you (explain if necessary):

Please describe your current concern and specific question(s) about your pet:

Please list names of people and names/species of other pets in household and their relationship to the animal in question:

If this is a followup consultation, please tell me the approximate date of the previous consultation. Also....Anything else you would like to tell me?:

Is this a followup consult? If so, what was the date of previous consult? Anything else? :

*** This form is submitted via email. Please do not add your credit card information to this form. If you do, it is like writing the information on a postcard and sending it through the mail - for all to see, at every step of the way.