Appointment Request Form Need to schedule an appointment? Use our quick and easy Appointment Request Form to let us know your preferred date and time. A member of our team will follow up shortly to confirm your booking. Appointment Request Name * Name First First Last Last Email * Phone * Pet's Name * Pet's Species * - Please Select -DogCatOther Pet's Species Is your pet a current patient at Sandy Paws Veterinary Clinic? * Yes No Are you the owner / Legal guardian of this pet? * Yes No **Please note we cannot treat a pet without owner’s written consent. If you are not the owner, we cannot treat the animal without owner’s permission. Please describe the reason for the appointment request and provide your upcoming availability and if you have a doctor you would prefer to see. * Preferred Day for Appointment * Preferred Time for Appointment * AM PM Please confirm you read and understood all the above by signing your full name below. NOTE THAT PAYMENT IS DUE AT TIME SERVICES ARE RENDERED. NO BILLING OR INVOICES. We accept the following forms of payment: Cash | Credit | Card | Scratch Pay Note: To help prevent and deter identity theft, we will require a current driver’s license or United States passport - to verify personal information and funds, if applicable. Thank You! I understand that FULL PAYMENT OF ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED TO MY PET and I shall take full responsibility for payment of all charges related to the care of my pet prior to leaving the clinic or when services have been completed. I acknowledge and accept that, should payments not be honored by my bank, credit card organization or by pet insurance organization to Sandy Paws Veterinary Clinic – for any reason – then I shall pay the full amount within five (5) days of demand – including all applicable costs incurred by Sandy Paws Veterinary Clinic (and its agents) for collection of those funds. RABIES VACCINE ACKNOWLEDGEMENT Rabies is a deadly disease that is transmittable to humans. Georgia Rabies Control Law-O.C.G.A.-13-19 mandates that every cat and dog be vaccinated for rabies by a licensed Veterinarian to protect them and to prevent the spread of this fatal disease.Sandy Paws Veterinary Clinic is abided by this law, and we ask all our clients to make sure their pets are up to date with their rabies vaccine to prevent any issues when needing to be seen at our office. Being up to date with this vaccine, not only protects you and your pet, but also our staff. As indicated by my signature, I have read and acknowledged all information provided to me on this Registration Form (on these two pages) and verify the information I have provided is correct. Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
