Name *

First Name

Last Name

Phone *

(###)

###

####

Type of appointment needed *

First Visit (New Patient) Adult

First Visit (New Patient) Child

First Visit (New Patient) Cat/Dog

First Visit (New Patient) Equine

First Visit (New Patient) Exotics

Regular Visit (Existing Patient) Human/animal

Transferring from another Clinic

On holiday or in your area and need help/advice

Other

Preferred date of the appointment

MM

DD

YYYY

Preferred Time

AM

PM

Any time of day

Who do you prefer to see?

Michael Lezuo

Emergency?

I need help ASAP