Appointment requests are reviewed during normal business hours only, but this form can be filled out at any time. A staff member of Waterloo Animal Hospital will contact you regarding your requested appointment -- an appointment is not scheduled until confirmed via telephone or email contact with you.

Owner information:

NOTE: If you are a new client of Waterloo Animal Hospital, please fill out this form as completely as possible. If you are a current client (within five years), you need only to provide your name and current telephone number, but feel free to update any information for us!

If you are a new client, please check here:

*Name:		*Phone:
Address:		Work Phone (Optional):
City:		Cell/Pager (Optional):
State:		Email:
Zip:

Patient Information:

If this is the first time we will see this animal, please check here:

Animal's Name (if applicable):

Species:Dog Cat Cattle Horse Pigs Sheep/ Goats Other

Sex:Male Female Neutered Male Spayed FemaleMixed/ Herd

Services Requested for Animal(s):

Veterinarian: No Preference Dwight D. Boehm, DVM Lizabeth A. Vollmer, DVM Allen M. Mueller, DVM Rebecca Black, DVM

Requested Appointment Date:

Requested Appointment Time:

Please provide any additional information about your animal(s) that you feel will be pertinent to the appointment:

Remember, this is an appointment REQUEST. Final arrangements will be made when a staff member of Waterloo Animal Hospital calls or emails you back.

Reply to me regarding this appointment by Telephone Email

Note: If your browser does not support forms or if this form is not functioning properly, you can still make an appointment request by simply submitting the above requested information in an email to appointments@waterlooanimalhospital.com