Request and Appointment

Request an Appointment

If this is a pet medical emergency, please directly call us or drive to the LAASER Hospital! Please do not complete this request form. Please note, this is a request, not a confirmed appointment. A client service coordinator will be in touch within 24 hours to further discuss the details of your appointment request.

Have you been to LAASER before?(Required)

Yes

Your doctors' name(Required)

Your name(Required)

Alternate name(Required)

"A different name the record could be under."

Patient (pet) name(Required)

Phone Number(Required)

Your Email(Required)

Department(Required)

Appointment request information

Please provide us more information on the situation of the appointment request.

How did you hear about us?(Required)

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