GREENWOOD LAKE ANIMAL HOSPITAL
Request an Appointment
Three Easy Steps to Request an Appointment
REQUIRED FIELDS IN RED
Client Information
First Name
Last Name
Preferred Phone
Alternate Phone
Email
Scheduling Information
First Preferred Day AM/PM
M-F 9:00AM - 12:NOON
M-F 2:00PM - 5:00PM
M-F 5:00PM - 7:00PM
SAT 8:30AM - 12:30PM
First Preferred Date
Second Preferred Day AM/PM
M-F 9:00AM - 12:NOON
M-F 2:00PM - 5:00PM
M-F 5:00PM - 7:00PM
SAT 8:30AM - 12:30PM
Second Preferred Date
Third Preferred Day AM/PM
M-F 9:00AM - 12:NOON
M-F 2:00PM - 5:00PM
M-F 5:00PM - 7:00PM
SAT 8:30AM - 12:30PM
Third Preferred Date
Select Your Preferred Professional
No Preference
Dr. Eric Louer
Dr. Kathleen Price
Dr. Janet Streng
Technician Appointment
What is a Technician Appointment?
Nail Trim
Heartworm Test
Routine Anal Gland Expression
Annual or Semi Annual Bloodwork
Monthly Injections
Subcutaneous Fluids
Therapy Laser
Suture Removal
MicroChip Implantation
Tick Removal
Reason for Visit
My Pet Is Sick - NOT an Emergency
Wellness Exam
Vaccine Booster
Schedule Dental Cleaning
Schedule Surgery
Other
IN AN EMERGENCY CALL 973-728-2233
What is an EMERGENCY?
Pet Information
Please Select One Option Below
1 - I Am a Current Client and my Pet HAS Been Here Before
2 - I am a Current Client but my Pet HAS NOT Been Here Before
3 - I am a New Client
Pet Name
Pet Type and Sex
MALE DOG
FEMALE DOG
MALE CAT
FEMALE CAT
Pet Name
Pet Type and Sex
MALE DOG
FEMALE DOG
MALE CAT
FEMALE CAT
Pet Breed
Pet Color
Pet Age
Current Medications
Known Allergies/Adverse Reactions to Medications or Vaccines
Neutered/Spayed
NEUTERED
SPAYED
NOT
Micro-Chipped/Tatooed
MICRO-CHIPPED
TATOOED
NOT
Referred By
New Client Address
Pet Name
Pet Type and Sex
MALE DOG
FEMALE DOG
MALE CAT
FEMALE CAT
Pet Breed
Pet Color
Pet Age
Current Medications
Known Allergies/Adverse Reactions to Medications or Vaccines
Neutered/Spayed
NEUTERED
SPAYED
NOT
Micro-Chipped/Tatooed
MICRO-CHIPPED
TATOOED
NOT
Additional Information
Your pet is going to have a comprehensive physical examination with one of our dedicated veterinarians.
In addition to this exam, it is crucial for our staff to learn from you any information that may indicate illness or injury in your pet.
Is there any other information that we should know about in order to provide the best care possible?
CLIENT AUTHORIZATION
By submitting this form, I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet.
I assume responsibility for all charges incurred in the care of this animal.
I also understand that these charges will be paid at the time of release and that a deposit will be required for surgical and or medical treatment.
I certify that I am more than 18 years of age.
I Agree and Authorize
leave me blank
HOME
BACK
CALL
Back to
Top