• Lap of Love Pet Registration form for The Greater Hampton Roads Region of Virginia

    Please complete the form below
  • Contact Information

  • Your Full Name

  • E-mail*

  • Phone Number

  • Alternate Phone Number

  • If you have not yet spoken to us, how would you like us to contact you?

  • Address

  • Driving instructions: From Interstate 664/64/264

  • Please name your Spouse, other Family Members, or other Pets that may be present for the appointment

  • How did you hear about Lap of Love?

  • If a friend referred you, please let us know their name

  • Your Pet’s Information

  • What is your Pet's Name?*

  • Please select your pet's species?

  • What breed is your pet?

  • What color is your pet?

  • Gender?


  • How old is your pet?

    yrs
  • How long have you had your pet?

    yrs
  • How much does your pet approximately weigh?*

    pounds
  • What is the main ailment of your pet?

  • Appointment Information

  • What is the name of your regular veterinarian?

  • What is the name of your regular veterinary clinic?

  • What type of Aftercare would you prefer?

  • If you have not yet scheduled a date and time for the appointment - what days and times would be best for you?

  • Any additional notes or comments?

  • If you'd like, please upload an image of your pet if you have one (32 meg max file size)