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Relief Veterinarian Information
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Doctor Name
*
First
Last
Doctor Email
*
Date of Appointment
Name of Patient
Owner's Last Name
Zip Code
House Call Fee
Cremation Fee
(excluding memorial items, shipping, etc)
Payment - Amount Received
What did the patient weigh
Body care?
Yes
No
Any additional notes
Payment Type
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Check
Cash
ScratchPay
Care Credit
PayPal
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