Dental Appointment Interest Form

This field is for validation purposes and should be left unchanged.
Client/Owner Name(Required)
Client name is it appears on the pet’s account
Email connected to the pet’s account
What would be the best way to reach out to you for next steps?
Name of the pet you’re interested in getting a dental exam for
Pet's Gender(Required)
Please enter a number from 0.5 to 20.
Age of the pet receiving dental services
Pet Type(Required)
Let us know about your pet’s most recent dental exam, how old they are, and a time frame that would work best for you for their annual dental exam.
Accepted file types: jpg, png, pdf, Max. file size: 50 MB.
Please upload your most recent medical records, including but not limited to healthy pet services, dental exams, and/or surgeries.
Thank you for choosing Emancipet for your pet’s dental care. This information will be shared with our Austin Dental and Surgical Center Team, and we will be in touch ASAP. For a faster response, please call 512-587-7729.