Make an Appointment - Wisconsin Veterinary Referral Center - Racine

Request an Appointment
- To request an appointment, please fill out the form below. A member of our team will contact you to confirm details.
- Client Information
- Client Name*
- Email Address*
- Phone Number*
- Address*
- City*
- Zip Code*
- State*
- Patient Information
- Pet Name*
- Pet's Age or Date of Birth*
- Species
- Sex of Pet
- Breed
- Family Veterinarian - Name
- Family Veterinarian - Clinic Name*
- Appointment Details
- Which Hospital is this Appointment For?*
  - WVRC - Waukesha
  - WVRC - Grafton
  - WVRC - Racine/Kenosha
- Which Department is this Appointment for?*
- Reason for Visit?*
- Best days of week for appointment
  - Monday
  - Tuesday
  - Wednesday
  - Thursday
  - Friday
- Would you prefer morning or afternoon?
Comments
This field is for validation purposes and should be left unchanged.