Now open in Scottsdale AND Mesa!
Click here for more info
Open M - F 7:30am - 4:30pm
Vaccine Clinic Open 8am-9am ONLY
Closed Saturdays Until Further Notice
Menu
Call
Directions
Pricing
Our Staff
Book Appt
Forms
Dental Care
Online Pharmacy
6835 E Thomas Rd Scottsdale, AZ 85251
(480) 874-DOGS (3647)
Open M-F 7:30am-4:30pm
Toggle navigation
Pricing
Forms
Dental
Our Staff
About
Contact
×
x
There something problem with the settings.. please check the setting for this.
New Client
Owner Name
*
Spouse/Other
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip
Phone (Primary)
*
Phone (Other)
Email Address
*
How did you hear about us?
*
Drive by/Signage
Internet
Mailer
PetCo/Petsmart
Facebook
Instagram
Rescue
Family Member/Friend
Other
Emergency Contact Name
Phone
If a friend or family member referred you, they will receive a $20 bonus credit for their next visit. Who may we thank for referring you today?
Do you have a referring clinic you would like us to send today's records to?
Is there a previous vet we can call for your pet's most recent medical records? If so, please provide the name of the veterinary practice and their phone number that we can call to request records.
Appointment Date
MM slash DD slash YYYY
Appointment Time
:
HH
Minute
AM
PM
AM/PM
Pet Name
*
Species
*
Canine
Feline
Avian
Rodent
Reptile
Rabbit
Hare
Marsupial
Ferret
Other (not listed)
Breed
*
Color
*
Gender
*
Male
Female
Is your pet spayed/neutered?
*
Yes
No
Birthday
MM slash DD slash YYYY
Age
*
Known allergies or pre-existing conditions
Upload Pet Picture
Accepted file types: jpg, gif, pngjpeg, Max. file size: 10 MB.
Have a 2nd Pet?
No
Yes
Pet Name
*
Species
*
Canine
Feline
Avian
Rodent
Reptile
Rabbit
Hare
Marsupial
Ferret
Other (not listed)
Breed
*
Color
*
Gender
*
Male
Female
Is your pet spayed/neutered?
*
Yes
No
Birthday
MM slash DD slash YYYY
Age
*
Known allergies or pre-existing conditions
Upload Pet Picture
Accepted file types: jpg, gif, pngjpeg, Max. file size: 10 MB.
Have a 3rd Pet?
No
Yes
Pet Name
*
Species
*
Canine
Feline
Avian
Rodent
Reptile
Rabbit
Hare
Marsupial
Ferret
Other (not listed)
Breed
*
Color
*
Gender
*
Male
Female
Is your pet spayed/neutered?
*
Yes
No
Birthday
MM slash DD slash YYYY
Age
*
Known allergies or pre-existing conditions
Upload Pet Picture
Accepted file types: jpg, gif, pngjpeg, Max. file size: 10 MB.
Have a 4th Pet?
No
Yes
Pet Name
*
Species
*
Canine
Feline
Avian
Rodent
Reptile
Rabbit
Hare
Marsupial
Ferret
Other (not listed)
Breed
*
Color
*
Gender
*
Male
Female
Is your pet spayed/neutered?
*
Yes
No
Birthday
MM slash DD slash YYYY
Age
*
Known allergies or pre-existing conditions
Upload Pet Picture
Accepted file types: jpg, gif, pngjpeg, Max. file size: 10 MB.
Disclaimer
*
I agree to the policy outlined below
By signing this form, I confirm and agree that I am the legal owner or the responsible party of the above-mentioned pet(s). I understand that payment for all services rendered is due at the time of treatment or services given. I understand that beginning at 30 days past due on any balance incurred, that interest charges will be assessed at 10% based on State Statute. If amounts owed exceed approximately 90 days past due, AZ Spay may use all legal methods to recover amounts owed including the Arizona Attorney General, or a local attorney. Collection charges will be added to the account and will be the responsibility of the client. If a court ordered judgment occurs, attorney fees will also be assessed. I understand photos and/or videos of my pet(s) might be used on social media or other online sources. If you do not wish for your pet’s photos/videos to be shared on social media, please let us know that you wish to opt out and we will note your account.
Forms of payment accepted: Cash, Visa, MasterCard, Discover, Amex, Care Credit and Bank Debit Cards
Signature
*
Comments
This field is for validation purposes and should be left unchanged.
X
Your Phone Number
*
Comments
This field is for validation purposes and should be left unchanged.