White Glove Service

Name: Harrisburg Regional Veterinary Surgical Specialty
Address: 989 East Park Drive, Suite A, Harrisburg, PA, 17111, United States
Telephone: 717-599-6131
Price range: $

General number (info & appointments): 717-599-6131
To check in ONLY: 717-599-4259

For the safety of our clients, patients, and nurses, we are currently operating 100% curbside. Our White Glove service provides the same excellent care to your pet. We are not allowing clients inside our building at this time. You WILL meet with the surgeon for any consultation and before any surgery. When you arrive at our practice, please call 717-599-4259 and our team will provide instructions for the next steps.

New Client Intake Form

GET STARTED

We can’t wait to see you!

Please complete your New Client Intake Form before your first visit. If you have any questions, feel free to call us!

Name *

First

Last

Email *

Best phone number to CALL today *

Best phone number to TEXT today *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Family Veterinarian *

Family Veterinary Hospital *

Pet's Name *

Age *

Date of Birth *

Species *

Dog
Cat
Other

If other, please specify *

Breed

Sex *

Male
Male (neutered)
Female
Female (spayed)

What time did your pet last eat? *

Has your pet been in contact with someone who may have or does have COVID-19 in the past 14 days? *

Is your pet: *

A family pet
A highly active pet
A working or sporting dog

Is your pet up-to-date on vaccines, including Rabies? *

Primary reason/concern for appointment *

When did the problem start? *

What treatment has been tried so far? *

Has this treatment helped? *

Yes
No
Somewhat

Has your pet had FULL bloodwork within the last 3 months (i.e. not just a Lyme test)? *

Has your pet had X-rays within the last few months? *

Is your pet currently taking any medications? *

List below, for each drug: name, mg or ml, frequency/day, quantity left *

Did you bring food for your pet? *

Please note: we cannot accept raw food

Your pet's appetite *

Increased
Normal
Decreased

Your pet's drinking/water intake *

Increased
Normal
Decreased

Is your pet coughing? *

Yes
No
Unsure

Is your pet sneezing? *

Yes
No
Unsure

Is your pet vomiting? *

Yes
No
Unsure

Does your pet have diarrhea? *

Yes
No
Unsure

Your pet's urination (select all that apply) *

Normal
Increased
Decreased
Blood present
Dark
Cloudy
Straining to urinate
Strong/foul odor

How will you be paying for this visit? *

Visa
American Express
Mastercard
Debit card
Scratchpay
CareCredit
Cash
Check
Pet insurance

Any previous patient's history we should be aware of? *

Does your pet have any allergies (including skin allergies & medications) we should be aware of? *

If yes, please explain *

Has your pet ever had an adverse or negative reaction to anesthesia? *

If yes, please explain *

Any additional information that you would like the surgeon to be aware of? *

Who were you referred by? *

Self
Family veterinarian
Someone I know
Social media
Website
Other

Who can we thank for referring you? *

If other, please specify *

If applicable, please kindly ask your family vet to email your pet’s recent medical record (ie pertaining to the current problem) & recent blood work (in PDF format) and recent X-rays (in JPEG format) to [email protected].

Signature *

Date *

Comment

We help your pet get back to feeling their best.

Privately owned Harrisburg Regional Veterinary Surgical Specialty is the first and only local veterinary surgery center in the Harrisburg area. We partner with your family vet to provide your pet with surgical expertise in orthopedic, “soft tissue” and cancer surgery. All we do is surgery!

We proudly serve pets in Pennsylvania (Dauphin County, York, Lancaster, Lebanon, State College, Reading, Wilkes-Barre & Scranton, Progress, Colonial Park, Hershey, Elizabethtown, Carlisle, Lehigh Valley, Philadelphia, Pittsburgh, Stroudsburg, Enola, Camp Hill, Mechanicsburg, Good Hope, Camp Hill, Dillsburg, Boiling Springs, York, Gettysburg, Lancaster, Lititz, Middletown), New Jersey (Phillipsburg, Blairstown, Morris Plains, Trenton), New York (Manhattan, Buffalo), Washington DC, Delaware, Maryland (Baltimore, Gaithersburg), West Virginia, Virginia, Ohio, North Carolina, and even Florida!

Need a hotel? We have so many clients from out of town and out of state that we created a list of nearby pet-friendly hotels.
Simply ask for it, so you don't have to reinvent the wheel.

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Location

989 East Park Drive, Suite A
Harrisburg, PA 17111

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Contact Info

P: 717-599-6131
E: [email protected]

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Hours

By appointment only.

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We will be in touch with you!

Name *

First

Last

Email *

Phone

How may we help you? *

Please Upload Medical Records (PDF), Blood Work (PDF), or X-Rays (MUST BE IN JPEG FORMAT) Here

Click or drag files to this area to upload. You can upload up to 15 files.

Website

Have questions?

Click the button below or call us directly at 717-599-6131. We'll be here to answer any and all of your questions.

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