San Francisco Veterinary Housecalls Appointments Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone or email, directly by Dr. Lum, and can help triage the situation as necessary. Thank you! Name* First Last Phone*Does this phone number allow texting?*YesNoEmail* Address* Street Address Cross Street City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Partner’s Name if applicable First Last Partner’s PhonePartner’s email Preferred days and times of days(i.e. Monday 11am-3pm, Thursday 1pm-8pm) The appointed time, agreed upon, is usually the earliest I’d be there, with a 60 minute window ETA, after the appointed time.During Covid-19 times, Dr. Lum will set up a time to chat on the phone, prior to the appointed housecall day, to help triage the housecall.Most of the consultation chat will be done at this phone call, instead of at the housecall, due to Covid issues.Of course masks are mandatory, and physical distancing as possible, AND to inform him prior, if anyone in the household is symptomatic or been exposed to, or has/had Covid-19.Doing dog exams outside, in yard, front of house, deck, garage, etc. is always helpful, but not imperative.Do you agree to the statement above?*YesNoPet Name* If multiple pets needing a housecall, please fill out a second form, or just put next pet's info, if same species, by separating with a slash /. Otherwise, please just list additional pets in household, with name, age, cat or dogSpecies*DogCatStrictly indoors?*YesNoHow are your cat[s], when friends or visitors come to the home?Breed*Please indicate breed or closest mix.AgeSexDo you have a bathroom scale at home?YesNo If so, please weigh your pet, by carrying it, double and triple checking the combined weight, then placing your pet down, and doing the same with your weight at that moment, double and triple checking it, and subtracting….Approximate WeightWhen and Where was your pet's last veterinary examPlease contact them and have them email me your pet’s complete medical records. The sooner I receive them, the sooner we can move forward, if needed.Nature of this upcoming visit with SFVH (please be as detailed as possible)*How did you hear of San Francisco Veterinary Housecalls?CAPTCHANameThis field is for validation purposes and should be left unchanged.