First Name (required)

Last Name (required)

Street Address (required)

Street Address (cont'd)

City (required)

State (required)

Zip/Postal Code (required)

Home Phone (required)

Work Phone

Email (required)

Name (required)

Species (required)
---CatDogOtherPlease leave this field empty.
If "other," please specify in comments section.

Age

Breed

Color

Sex (required)
---MaleMale - neuteredFemaleFemale - spayed

Services Requested
ExamVaccinationsDentalNeuter/SpayBathNail TrimOther

Requested Date for Appointment (required)

Requested Time for Appointment (required)
---9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm4:30 pm (NOT AVAILABLE SAT)5:00 pm (NOT AVAILABLE FRI OR SAT)5:30 pm (NOT AVAILABLE FRI OR SAT)6:00 pm (NOT AVAILABLE FRI OR SAT)6:30 pm (NOT AVAILABLE FRI OR SAT)7:00 pm (NOT AVAILABLE FRI OR SAT)7:30 pm (NOT AVAILABLE FRI OR SAT)8:00 pm (NOT AVAILABLE FRI OR SAT)

Requested Veterinarian (required)
---No PreferenceDr. Jean MeadeDr. Jesse FallonDr. Chuck WolfeDr. Raye KlarerDr. Kim LeidlDr. Becky LeapDr. Laura MeansDr. Marjorie Rosmarin

Comments:

Payment is required on the day services are provided. We accept cash, checks, VISA, MasterCard, and Discover. If you have concerns about your charges, please request an estimate prior to receiving services or call (304) 594-1124.

Appointment requests should be made 24 hours in advance. Appointments are not scheduled until confirmed by Cheat Lake Animal Hospital. How should we contact you to confirm your appointment? (required)
---E-mailHome phoneWork phone