HOME VET CARE
Mobile Veterinary Housecall Service
Michael H. Kaufman, DVM
954.755.2662
Serving Broward and Palm Beach, Florida since 1989

Appointment Request

Appointment Request

Thank you for requesting an appointment with HOME VET CARE.  We look forward to meeting your veterinary needs.
Please remember that your appointment needs to be confirmed.  Someone from our staff will be in contact with you soon.

 

Form - Appointment Request

Name (required)
First Name (required)
Last Name (required)
E-Mail Address (required) :
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone
Phone TypePhone Number
Pet's Name (required)

Type of Pet (required)
Canine
Feline

Breed (required)

Date of Birth (required)

Sex: (required)
Male
Female

Has your pet been spayed or neutered? (required)
Yes
No

Are your pets vaccines current? (required)
Yes
No

Reason for Appointment (required)
Physical Examination
Appropiate Vaccinations
Sick Pet
Surgery
Other

Medical records at another veterinary Practice?
Yes
No

Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No

Please list your preferred dates and times for an appointment

How did you hear about HOME VET CARE

Please list any additional pets or requests here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at HOME VET CARE and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly service charge.
I have read this statement and - (required)
I Agree
I Disagree


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