Specialty Appointment Request - Avets Specialty & Emergency Trauma Center

If you are interested in scheduling a consultation with one of our specialists, please fill out our appointment request form below so we can coordinate a referral from your primary care veterinarian.

Once we receive a referral from your veterinarian we will connect with you to schedule a convenient time for your pet’s consultation.

Veterinarian Information

Primary Veterinarian*

Practice Name*

Client Information

Client Name*

First Name Last Name

Client Address*

Street Address Address Line 2 City State ZIP Code

Client Email*

Client Phone*

Patient Information

Pet's Name*

Species*

Breed

Age

Sex/Reproductive Status

Department you're requesting an appointment with:*

Reason for Your Appointment Request:*

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Name

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