Owner information

Owner's first and last name

Owner's phone number

Owner email

Owner's full address

Pet information

Pet Name

Weight in kilograms

Species

Sex

Race

Patient's age (in years)

One of these boxes must be checked for the query to be completed.

I'd like to try to schedule surgery at my veterinarian's office with Coupez.

My vet refers me for surgery with Coupez.

Note: You can schedule a virtual or in-person consultation yourself here.

Condition requiring surgery

One of these boxes must be ticked for the query to be completed.

I will send my pet's file to contact@coupez.ca.

I advise my veterinarian to send my pet's file to contact@coupez.ca.

I already have my pet's file.

Animal medical file

One of these boxes must be checked for the query to be completed.

I will send my pet's X-rays to contact@coupez.ca.

I advise my veterinarian to send my pet's x-rays to contact@coupez.ca.

I already have my pet's X-rays.

N/A

X-rays of the animal

Name of veterinary establishment

First and/or last name of the treating veterinarian

Address of veterinary establishment

Telephone of the veterinary establishment

Address of veterinary establishment

You'd like us to evaluate or operate on your pet, but your veterinarian is not one of our partners (yet)?

Please contact us!