Animal Allergy & Dermatology Center of Central TX

2207 Lake Austin Boulevard
Austin, TX 78703

(512)477-4824

aadcaustin.com

Appointment Request

If you would like to make an appointment, you can expedite the process by submitting this form.

Thank you for your cooperation in allowing us to assist you.

Appointment Request

Name & Email (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pet's vaccines current?
Do you have your pet's medical records?
Medical records at another veterinary practice?
Yes
No


Name of primary care veterinary practice

May we request a transfer of records?
Yes
No


Would you like us to call you for your appointment?
Reasons or conditions that prompted your inquiry?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Animal Allergy & Dermatology Center of Central TX and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Animal Allergy & Dermatology Center of Central TX's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I Agree
I Disagree



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