Your Name
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First
Last
Phone
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Email
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Have you visited us before?
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Yes - current client
No - this is our first visit
Animal or herd name
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For herds, write e.g. cow herd, goat herd, chicken flock
Species
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Dog
Cat
Horse / Donkey / Mule
Cattle
Goat
Sheep
Pig
Alpaca / Llama
Poultry / Bird
Rabbit
Pocket pet (rodent, ferret)
Reptile
Exotic
Other
Please describe the species
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Breed
Number of animals
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Animal’s age
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Where should we see your animal?
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Sumter: At our practice (1038 Broad St, Sumter)
Farm call
Farm address
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Address (street, city, state, ZIP)
Reason for the visit
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Physical Exam
Semi-Annual Comprehensive Exam
Vaccinations
Heartworm Testing
Coggins Testing
McMaster Fecals
Preventative Care
Herd Health General Care
Herd Health Write-Up
Hoof Trimming
Dental Floating
Geldings & Castrations
Health Transport Certificate
Digital Radiology / X-Rays
Ultrasound
Diagnostic Laboratory
Allergy Testing
Maintenance Care
Dental Care
Dental Extractions
Surgery (small or large animal)
Internal Surgery
Fractures & Dislocations
Amputation
Internal Medicine
Other — I'll explain below
Reason for the visit
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Preferred date
MM slash DD slash YYYY
Preferred time of day
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Morning (9am–12pm)
Afternoon (12–3pm)
Late afternoon (3–5pm)
Any time that's open
Anything we should know?
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It’s OK to text me at the number above about this request. Message and data rates may apply — reply STOP any time to opt out.
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Yes
No
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