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2. 

4. We have a pet clinic that may be able to help owned pets in our community with medical issues or even routine care. THIS CLINIC IS FOR ORANGE COUNTY NORTH CAROLINA RESIDENTS.

   This clinic was only recently implemented, our resources for these clinic services are currently limited and we appreciate your patience as we navigate and refine this process. Please know that it may take several business days for us to respond.

   This clinic is not for emergencies or urgent medical needs  - please contact your veterinarian or an emergency veterinary clinic if your pet needs immediate attention.

   Please fill out the form below and someone will respond as soon as possible.

6. Your Full Name*
7. Email Address*
9. Confirm Email Address:*
10. Phone Number*
12. Address*
14. City*
15. State*
16. Zip Code*
20. PET INFORMATION
22. Your Pet's Name*
23. Pet Type*
    -- Select One --DogCatRabbitOther (please describe in section below)
24. Sex*
    -- Select One --MaleFemaleNeutered MaleSpayed FemaleUnknown
26. Pet Age*

    Specify years and/or months

27. Breed*
28. Color*
29. Size*
    -- Select One --SmallMediumLargeX-LargeKittenPuppy
31. Please describe your pet's medical needs:*
33. Has this pet been to our clinic OR our shelter before?*

    1. NO
    2. YES
34. Did this pet have a different name before? If so, what was that name?
36. Do you need to list another pet in this inquiry?*
    -- Select One --NoYes
40. Your Pet's Name
41. Pet Type
    -- Select One --DogCatRabbitOther (please describe in section below)
42. Sex
    -- Select One --MaleFemaleNeutered MaleSpayed FemaleUnknown
44. Pet Age

    specify years and/or months

45. Breed
46. Color
47. Size
    -- Select One --SmallMediumLargeX-LargeKittenPuppy
49. Please describe your pet's medical needs:
51. Has this pet been to our clinic OR our shelter before?*

    1. NO
    2. YES
52. Did this pet have a different name before? If so, what was that name?
54. Do you need to list another pet?
    -- Select One --NoYes
58. Your Pet's Name
59. Pet Type
    -- Select One --DogCatRabbitOther (please describe in section below)
60. Sex
    -- Select One --MaleFemaleNeutered MaleSpayed FemaleUnknown
62. Pet Age

    specify years and/or months

63. Breed
64. Color
65. Size
    -- Select One --SmallMediumLargeX-LargeKittenPuppy
67. Please describe your pet's medical needs:
69. Has this pet been to our clinic OR our shelter before?*

    1. NO
    2. YES
70. Did this pet have a different name before? If so, what was that name?
72. Do you need to list another pet?
    -- Select One --NoYes
76. Your Pet's Name
77. Pet Type
    -- Select One --DogCatRabbitOther (please describe in section below)
78. Sex
    -- Select One --MaleFemaleNeutered MaleSpayed FemaleUnknown
80. Pet Age

    specify years and/or months

81. Breed
82. Color
83. Size
    -- Select One --SmallMediumLargeX-LargeKittenPuppy
85. Please describe your pet's medical needs:
87. Do you need to list another pet?
    -- Select One --NoYes
91. Your Pet's Name
92. Pet Type
    -- Select One --DogCatRabbitOther (please describe in section below)
93. Sex
    -- Select One --MaleFemaleNeutered MaleSpayed FemaleUnknown
95. Pet Age

    specify years and/or months

96. Breed
97. Color
98. Size
    -- Select One --SmallMediumLargeX-LargeKittenPuppy
100. Please describe your pet's medical needs:
102. Do you need to list another pet?
     -- Select One --NoYes
106. Your Pet's Name
107. Pet Type
     -- Select One --DogCatRabbitOther (please describe in section below)
108. Sex
     -- Select One --MaleFemaleNeutered MaleSpayed FemaleUnknown
110. Pet Age

     specify years and/or months

111. Breed
112. Color
113. Size
     -- Select One --SmallMediumLargeX-LargeKittenPuppy
115. Please describe your pet's medical needs:
119. How would you prefer to be contacted?*

     1. Phone
     2. Email
120. Please let us know more about your availability as far as bringing pets for clinic services (best days/times etc.)*
122. 
124. Need assistance?

     Please email petclinic@orangecountync.gov. Thank you in advance for your patience as it may take us several business days to respond.

Leave This Blank:


126. 1. Receive an email copy of this form.
127. Email address

     This field is not part of the form submission.

128. Submit

* indicates a required field