Mobile Veterinary Services

Birds & Fish
PO Box 1274
Taylors, SC 29687
(864)483-9940


 

Mobile Veterinary Services for Birds and Fish

PO Box 1274
Taylors, SC, SC 29687

(864)483-9940

www.birddoctor.net

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you. We do not give your email address to 3rd parties and intend to email you when providing invoice receipts, client education handouts, case followup information, and appointment reminders.

As you have made an appointment or are requesting an appointment, in addition to filling out this form, before the visit, please also fill out either an avian or aquatic history form.

New Client

Name (required)
First Name (required)
Last Name (required)
Name
First Name
Last Name
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
If you have a gate code, please write it here

Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone
Phone TypePhone Number
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Species (common name) (required)

Sex:

Male
Female


Gender confirmed?

Yes
No


Any chronic medical history?
Do you have pets medical records?
Medical records at another veterinary Practice?

Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?

Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

Please list any additional pets here (we don't treat dogs and cats)


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Mobile Veterinary Services

Birds & Fish
PO Box 1274
Taylors, SC 29687
(864)483-9940