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About
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Online Pharmacy
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Request an Appointment
About
Services
Client Resources
Online Pharmacy
Careers
Request an Appointment
Appointment Request Form
"
*
" indicates required fields
Name
This field is for validation purposes and should be left unchanged.
Client Name
*
First
Last
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
*
Phone
*
Who referred you/How did you hear about us?
First
Horse Name
*
Name
Breed
*
Gender
*
Age
*
Color
*
Equine's Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Primary Concern for Appointment
*
Appointment Booking Fee
*
Please adhere to our appointment policy:
We require a $35.00 booking fee for all appointments. Your credit card will remain encrypted and not charged until an appointment is created between you and Iowa Equine. The booking fee will become a credit to be used at your appointment. If the appointment is rescheduled, this booking fee will be honored for the reschedule. After two reschedules, the booking fee is collected. If an appointment is cancelled without reschedule, the booking fee is collected.
We require full payment at time of service.
I have read and agree to the appointment booking terms
Name on Card
*
First
Last
Card Number
*
Expiration Date
*
CCV
*
CAPTCHA
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