Appointment Request

Appointments are reviewed during hours that the hospital is open. If a response is not received within your desired time frame, please call us at (561)848-4349. Village Animal Clinic 9044 Alt A1A North Palm Beach, Fl. 33403 561-848-4349 *Client Name: (Name the pet's file is listed under) *Client Email: *Phone: (Please include area code) Home Work Cell Phone: (Please include area code) Home Work Cell Phone: (Please include area code) Home Work Cell Best Time To Call: -Time- 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 A.M. P.M. *Pet's Name: Your pet is a: -Select One- Dog Cat Reptile Bird Ferret Rabbit Pocket Pet Other If other please specify: Your pet's sex: Select One Male Female Neutered Male Spayed Female Not Sure Service Requested: Select One Annual Visit Diagnostic Exam Recheck Exam Vaccinations Yearly Labwork Neuter/Spay Declaw Heartworm Check Dental other Briefly list any medical reasons for visit: If other please specify: After my appointment I would also like to pick up: Heartworm Prevention: Select One Heartgard Plus Revolution Interceptor Sentinel Flea Prevention: Select One Frontline Topspot Advantage Program Comfortis If other please specify: Veterinarian of Choice: Select One Dr. Prior Dr. Wilson Dr. Berkenblit Dr. Degen No Preference Date you would like to schedule your pet's appointment: -Select one- Jan Feb March April May June July August Sept Oct Nov Dec -Day- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A.M. P.M. IMPORTANT: Appointment is not made until confirmed by a Village Staff Member. Please be sure you've entered a phone number (Including area code) and the best time to reach you, or your email address so that we can contact you for confirmation.