Please note: All credit card purchases will incur a 3% fee, and we require a $50 deposit for new client appointments.

Urgent Care Form

Save time at your next appointment! Please complete your required Urgent Care Form online from any device at any time before your visit.

Get Started

Urgent Care Form

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at 419-483-8549 for a faster response.

Are you an existing client? *

Existing Client

Please fill out this section if we have seen any of your pets before. If you are bringing a new pet, please choose the new pet exam option on the following page to provide their information.

Owner's Name *

Pet Name *

Species (dog, cat, etc) *

Are you bringing multiple pets to your visit? (if yes, fill out separate forms for each) *

Owner Information

Name *

Email (will be used to share lab results) *

Secondary Owner

How did you hear about us? *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Best phone number to reach you at *

Secondary phone number. Whose phone number is this?

Do we have permission to text these phone numbers? *

Yes, both
Only the primary number
Only the secondary number
Please only call me

Would you like access to your pets online portal (to see vaccine records, etc.) *

Can we post photos of your pet(s) on our social media pages (without any identifying information)? *

Pet information

Please fill out this section for each pet you own. If you are bringing multiple pets, please provide general information for each here, then fill out the next section for the first pet. Then, complete the form as an existing client for additional animals

Name *

Species (dog, cat, etc) *

Breed *

Sex *

Male
Female

Spayed/Neutered *

Yes
No
Unsure

Markings and color *

Date of birth (approximate if unknown) *

Is your pet microchipped or tattooed? If yes, please type microchip number or tattoo below if known *

Do you have more pets you need to provide information for? *

Name *

Species (dog, cat, etc) *

Breed *

Sex *

Male
Female

Spayed/Neutered *

Yes
No
Unsure

Markings and color *

Date of birth (approximate if unknown) *

Is your pet microchipped or tattooed? If yes, please type microchip number or tattoo below if known *

Do you have more pets you need to provide information for? *

Name *

Species (dog, cat, etc) *

Breed *

Sex *

Male
Female

Spayed/Neutered *

Yes
No
Unsure

Markings and color *

of cat, Do

Date of birth (approximate if unknown) *

Is your pet microchipped or tattooed? If yes, please type microchip number or tattoo below if known *

Purpose of Visit

What are we seeing your pet for?

New Pet Exam for existing client
New Pet Exam for new client
Third ChoiceAnnual Exam (vaccines, wellness exam)
Technician Appointment (heartworm test, blood test)
Recheck an issue we have seen you for recently
Drop off for diagnostics or anesthetic procedure (must be scheduled in advance)
Medical Condition/Concern or Illness
Other

What are we seeing your pet for? Please provide all information that may be important.

Are there any other concerns or additional details you feel are important to share prior to your appointment?

Please email any veterinary records for your pet to FourCountyOffice@gmail.com prior to your appointment.

If you only have paper records, please bring them with you to your appointment. You may also have a prior veterinarian email your records to this email address. These records provide us with important information which help us to treat your pet.

Ready for a visit?

We proudly serve the pets of Bellevue, OH, and the surrounding areas. We look forward
to seeing you and your pet! Request an appointment by clicking the button below.

Call Us

Contact Four County Veterinary Services

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Location

107 Progress Dr. Suite B
Bellevue, OH 44811

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Contact Information

419-483-8549
fourcountystaff@gmail.com

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opening hours

Monday – Thursday:
8:00 AM – 6:00 PM
(closed 12 pm – 1 pm for lunch)
Friday:
8:00 AM – 2:00 PM
Saturday:
8:00 AM – 12:00 PM

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