Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you! Name First Last PhoneEmail* Date of Requested Appointment* MM slash DD slash YYYY Species (Dog & Cat)BreedGender*MaleFemaleStatus*SpayedNeuteredIntactedPet Age | MonthsPet Age | YearsPet NameDo you have Pet Insurance? Yes Nature of VisitPrivacy and Consent By providing my phone number, I consent to receive SMS text messages from Ambleside Veterinary Hospital for appointment reminders, marketing messages and general two-way communication. Message frequency varies. Message & data rates may apply. When you receive a text message, you can reply HELP for support or reply STOP to opt out. Refer to our Privacy Policy and our Terms and Conditions for more information. CommentsThis field is for validation purposes and should be left unchanged.