Pre-Dental Appointment Request and Pet History Form

We require a deposit and a Pet History form to schedule your pet's pre-dental appointment.

Submitting this form will charge your card for the deposit.

After you submit this form, our schedulers will review it and select the earliest appointment date possible. You will receive a text message and email with the appointment date and time.

Please enter a valid phone number.Format: (000) 000-0000.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Pet's Age
(years) Years and (months* Months

Submitting this form will charge your card for the total indicated in the service selection area below.

ONLY SUBMIT THIS FORM ONCE FOR EACH PET.

If you need to change service selections, cancel, or reschedule after submitting the request, contact our Customer Help team. Notice of at least one business day prior to the appointment is required to receive a refund for cancellation.

Phone: (907) 562-2999

Email: customerhelp@alaskaspca.org

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

A 3% surcharge on credit card transactions is automatically collected upon submission of the payment. Debit cards are not assessed this surcharge.

If a surcharge is collected, the total on this form and what you will see on your card statement may be different. At the time of scheduling, our customer service team will send you a receipt which reflects the total charged (please allow 24-48 business hours).

Pre-Dental Appointment Request and Pet History Form

Owner Information

Pet Information

Health and History

Appointment Deposit