Specialty Appointment Request Form - Portland Veterinary Emergency and Specialty Care

Speciality Appointment Request Form

Thank you for considering us for your pet’s specialty care. Please fill out the form below to request a non-critical specialty appointment. Our team will review your request and respond within 24-48 hours during our business hours, Monday through Friday. If your pet is experiencing an emergency or requires urgent care, please call us immediately at 207-878-3121.

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Your Information

Your Name(Required)

First Last

Your Address(Required)

Street Address City State ZIP Code

Your Phone(Required)

Your Email Address(Required)

Have you visited PVESC previously (either emergency or speciality)?(Required)

Preferred Day for Scheduling(Required)

Patient Information

Patient Name(Required)

Date of Birth(Required)

Color(Required)

Species(Required)

Breed(Required)

Is your pet spayed or neutered?(Required)

Appointment Request Information

Type of Appointment(Required)

Speciality Department(Required)

Referral Information

Referring Veterinary Hospital(Required)

Please list any other hospitals this patient has visited in the last 5 years(Required)

Additional questions or notes about the appointment request(Required)