PAMLICO ANIMAL HOSPITAL
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Adopt one of our awesome pets!
Which of our available pets are you applying for?
Untitled
*
*
Indicates required field
Name
*
First
Last
Phone Number
*
Email
*
Occupation/Employer
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
How many people currently reside in your household?
*
How many children?
*
Do any members of your family have any allergies to animals?
*
Where do you live?
*
House
Townhouse
Apartment
Condo
Mobile Home
Farm
Where will the pet be kept?
*
Indoors
Outdoors
Both indoors and outdoors
If you move, what will you do with the pet?
*
If you currently have any pets, describe those that you care for or are living in your household.
Name
*
Breed
*
Age
*
Spayed/Neutered?
*
Spayed
Neutered
Neither
Kept where?
*
Time in your care?
*
Name
*
Breed
*
Age
*
Spayed/Neutered?
*
Spayed
Neutered
Neither
Kept where?
*
Time in your care?
*
Name
*
Breed
*
Age
*
Spayed/Neutered?
*
Spayed
Neutered
Neither
Kept where?
*
Time in your care?
*
Please provide the name of your veterinarian or where you plan to take this pet:
Untitled
*
Are you financially able and willing to provide annual check-ups, vaccinations, heartworm/flea/tick prevention, and ANY medical care necessary?
*
Yes
No
Do you agree to return the dog to Pamlico Animal Hospital in the event you are unable to keep the dog?
*
Yes
No
By applying my electronic signature to this form, I/we acknowledge that all information on this form is true and correct. If my/our request for adoption is approved and later Pamlico Animal Hospital discovers the above information is not true, Pamlico Animal Hospital reserves the right to remove the adopted pet from my household and refuse any future adoption applications.
Applicant's electronic signature
*
Date
*
Submit
Home
About
Our Doctors
Our Leadership Team
Our Facility
Services
Cold Laser Therapy
After Hours Care
Pet Resort
>
Pet Resort Check-in
Community
Contact Us
Jobs
Veterinarians Wanted
Pet Pictures
Our Patients
Staff Pets
Adoptable Pets
Pet Adoption
Pamlico Mobile
Farm Animal - Services
Farm Animal - Contact Us
Farm Animal - Upcoming Events