Schedule an Urgent Care Appointment

If you have more than one pet that needs to be seen, please call us. If this is an emergency, please go directly to the ER. No appointment needed.

Please select the MedVet location(Required)

Please select a date and time from the available appointments(Required)

Once a date and time is selected, we will hold the appointment for 15 minutes while you complete the form.

Your Information

Client Name(Required)

First Last

Cell Phone(Required)

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Home Phone

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Date of Birth

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License Number

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License Issuer/State

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License Expiration Date

Is this your first time visiting this MedVet location?

Yes

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Secondary Contact

First Name

Last Name

Cell Phone

Your Pet

Pet's Name(Required)

Pet's Species(Required)

Pet's Breed (please select species first)(Required)

Pet's Gender(Required)

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Pet's Color

Pet's Date of Birth(Required)

Please provide an estimate if not known.

Reason for Visit(Required)

Please describe reason(Required)

Name of Your Pet's Veterinary Clinic(Required)

If you do not have a primary veterinarian, type 'None'.

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Veterinary Clinic Phone

If you do not have a primary veterinarian, or do not know their phone number, type '000-000-0000'.

Name of Your Pet's Veterinarian(Required)

If you do not have a primary veterinarian, type 'None'.

Consent for Education and Research Use

MedVet may use and disclose information from my pet’s medical record, including medical information, demographic information, and images for educational and learning purposes, scientific investigations, and research publications. My pet’s information may be disclosed to veterinarians, veterinary technicians, students, research collaborators, and other personnel within and outside of MedVet. All personal identifying information will be removed prior to disclosure to individuals outside of MedVet and prior to presentation and/or publication.

Please select your choice(Required)

I DO Authorize

I DO NOT Authorize

Consent for Media Use

MedVet may use my pet's first name, photograph and clinical information on MedVet's website, social media, news media page or within informational pamphlets. Under no circumstances will my name, my personal or financial information be shared through these media sources.

Please select your choice(Required)

I DO Authorize

I DO NOT Authorize

Payment Policy

I have reviewed and verified that the above information is accurate to the best of my knowledge. I understand that payment in full is expected at the time my pet is released. I may be asked to leave a deposit if my pet is hospitalized overnight for further treatment. An estimate of care options will be discussed prior to treatment. In life-threatening situation, stabilizing care may be instituted upon arrival, but no invasive or diagnostic treatment will be undertaken until it has been discussed with me. The Client Service Representative will be happy to discuss the payment options available to me.

Signature

Date

If you have any questions, please call the MedVet Urgent Care
MedVet Columbus: 614.846.5800

If you have any questions, please call the MedVet Urgent Care
MedVet Cincinnati: 513.561.0069

If you have any questions, please call the MedVet Urgent Care
MedVet Cleveland: 216.362.6000

If you have any questions, please call the MedVet Urgent Care
MedVet Dayton: 937.293.2714

If you have any questions, please call the WestVet Boise Urgent Care
WestVet Boise: 208.375.1600

If you have any questions, please call the MedVet Dallas ER
MedVet Dallas: 972.994.9110

If you have any questions, please call the MedVet Norwalk Urgent Care
MedVet Norwalk: 203.838.6626

If you have any questions, please call the MedVet Urgent Care
MedVet Sandy: 801.758.7633