- Step 1 of 4

Are you a new or existing client? *

Primary Contact

Name: *

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone Number: *

Phone Type:

Email Address: *

Would you like to add another person to your account?

Additional Contact

Name: *

First

Last

Relationship:

Phone Number:

Phone Type:

Email Address:

Is this person your emergency contact?

Appointment request details

Primary Pet

Pet Name: *

Species: *

Reason for appointment request: *

If your pet is experiencing an emergency, or if your pet has had consistent bleeding, vomiting, diarrhea, or lethargy for more than 24 hours, please call us immediately at (952) 884-4353, or BluePearl Pet Hospital in Eden Prairie at (952) 942-8272. Please allow up to 1 business day for a reply to your request.

What symptoms is your pet experiencing? *

Gender: *

Breed:

Colors:

Age or Birthdate:

Has this pet been seen at another clinic? *

Name of previous clinic: *

Medical Records Upload:

If you have medical records from your previous clinic(s), feel free to attach them here. We can always work with you or your prior clinic(s) to retrieve them for you at a later time.

Additional Pets

Would you like to add a second pet to this appointment request?

Second Pet

Pet Name: *

Species: *

Reason for appointment request: *

What symptoms is your pet experiencing? *

Gender: *

Breed:

Colors:

Age or Birthdate:

Has this pet been seen at another clinic? *

Name of previous clinic: *

Medical Records Upload:

If you have medical records from your previous clinic(s), feel free to attach them here. We can always work with you or your prior clinic(s) to retrieve them for you at a later time.

Would you like to add a third pet to this appointment request?

Third Pet

Pet Name: *

Species: *

Reason for appointment request: *

What symptoms is your pet experiencing? *

Gender: *

Breed:

Colors:

Age or Birthdate:

Has this pet been seen at another clinic? *

Name of previous clinic:

Medical Records Upload:

If you have medical records from your previous clinic(s), feel free to attach them here. We can always work with you or your prior clinic(s) to retrieve them for you at a later time.

Preferred Appointment Time #1: *

Date

Time

Preferred Appointment Time #2:

Date

Time

Preferred Appointment Time #3:

Date

Time

Is there anything else you'd like us to know about this request for an appointment?

How did you hear about us?

Services agreement: *

By checking this box, you agree that Nova will gladly discuss the cost of services or prepare a written estimate for recommended procedures upon request. Payment is due at the time services are rendered. We accept cash, debit, all major credit cards, and Care Credit.

COVID-19 protocol agreement: *

By checking this box, you agree that under our COVID-19 curbside protocols, interactions will be conducted over the phone and you will remain in our parking lot for the duration of your appointment.

Name

Request an Appointment

Primary Contact

Additional Contact

Appointment request details

Primary Pet

Additional Pets

Second Pet

Third Pet

Nova Veterinary Clinic