Register for a Wellness/Sick Visit

Title

First Name*

Last Name*

Email Address*

Message*

Street Address*

City*

State*

Zip *

Cell Phone*

Home Phone*

How did you hear about us?*

Pet #1 Name*

Species

CatDog

Breed*

DOB (month/day/year) or Age*

Sex*

MaleFemale

Spayed or Neutered?*

YesNo

Weight*

How long have you had your pet?*

Where did you get your pet from?*

Microchip # (if applicable)

Medical History-previous disease, surgeries, vax (with dates)*

Current medication(s), Flea/tick preventative? If not applicable write "none"*

Any history of vaccine reactions/drug allergies?*

Diet (brand, amount given each day)*

Any vomiting or diarrhea on a consistent basis?*

Any coughing/sneezing on a consistent basis?*

Cats: How many litter boxes? Are litter boxes covered or uncovered?

Cats: Type of litter

Cats: Does your cat go outside? If so, do they roam?

Any other pets in the household?*

Additional comments/concerns

Pet #2 Name (If no other pets, scroll to bottom and click on "Send Message")

Species

CatDog

Breed

DOB (month/day/year) or Age

Sex

MaleFemale

Spayed or neutered?

YesNo

Weight

How long have you had your pet?

Where did you get your pet from?

Microchip # (if applicable)

Medical History-previous disease, surgeries, vax (with dates)

Current medication(s), Flea/tick preventative? If not applicable write "none"

Any history of vaccine reactions/drug allergies?

Diet (brand, amount given each day)

Any vomiting or diarrhea on a consistent basis?

Any coughing/sneezing on a consistent basis?

Cats: How many litter boxes? Are litter boxes covered or uncovered?

Cats: Type of litter

Cats: Does your cat go outside? If so, do they roam?

Additional comments/concerns

Pet #3 Name

Species

CatDog

Breed

DOB (month/day/year) or Age

Sex

MaleFemale

Spayed or neutered?

YesNo

Weight

How long have you had your pet?

Where did you get your pet from?

Microchip # (if applicable)

Medical History-previous disease, surgeries, vax (with dates)

Current medications, Flea/tick preventative? If not applicable write "none"

Any history of vaccine reactions/drug allergies?

Diet (brand, amount given each day)

Any vomiting or diarrhea on a consistent basis?

Any coughing/sneezing on a consistent basis?

Cats: How many litter boxes? Are litter boxes covered or uncovered?

Cats: Type of litter

Cats: Does your cat go outside? If so, do they roam?

Additional comments/concerns

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Contact Information

Elsa I Campos, VMD

(main) 973-900-9977

(cell) 973-913-4558

Hours of Operation:

*Mondays, Tuesdays, Thursdays and Fridays for inquiries

*Mondays, Tuesdays and Fridays for visits

*Closed: Wednesdays, Saturdays and Sundays

Address:

Dr. PetLover, LLC

P.O. Box 582

South Orange, NJ 07079

Dr. PetLover, LLC Mobile Veterinarian

Offering a complete and unique in home veterinary service experience
Servicing parts of New Jersey (counties include Union, Essex, Middlesex, Morris, Passaic)
Register to inquire if we service your area

Please get in touch!

Online Registration

Contact Information