{"id":468,"date":"2026-04-21T20:48:37","date_gmt":"2026-04-21T20:48:37","guid":{"rendered":"http:\/\/vetcpt.test\/?page_id=468"},"modified":"2026-05-26T12:11:24","modified_gmt":"2026-05-26T16:11:24","slug":"get-a-vet","status":"publish","type":"page","link":"https:\/\/vet.mattryan.co\/","title":{"rendered":"Get a vet"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and 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                   <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/index.php\/wp-json\/wp\/v2\/pages\/468' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_1\" class=\"gfield gfield--type-select populate-vets gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_1'>Vet<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_4_1' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select a Vet<\/option><option value='2107' >5 Mile Vet<\/option><option value='2108' >9-Tel Animal Hospital<\/option><option value='2109' >A W Animal Hospital<\/option><option value='2110' >A-Care Animal Clinic<\/option><option value='2111' >A-Quality Care Veterinary Hospital<\/option><option value='2112' >Ace Animal Clinic<\/option><option value='2113' >Advanced Animal Emergency<\/option><option value='2114' >Advanced Pet Care of Oakland<\/option><option value='2115' >Advanced Veterinary Care Group Canton<\/option><option value='2116' >Advanced Veterinary Medical Group<\/option><option value='2117' >AEC Novi<\/option><option value='2118' >AEC Rochester<\/option><option value='2119' >Affiliated Veterinary Emergency Service<\/option><option value='2120' >Affordable Veterinary Care Center<\/option><option value='2121' >Airport Veterinary Hosp.<\/option><option value='2122' >Alexis Road Animal Hospital<\/option><option value='2123' >Alfa Animal Care-Farmington Hills<\/option><option value='2124' >Alfa Animal Care-Sterling Heights<\/option><option value='2125' >All About Animals<\/option><option value='2126' >All Creatures Veterinary Services<\/option><option value='2127' >Allen Animal Hospital<\/option><option value='2128' >Almont-Dryden Veterinary Hospital<\/option><option value='2129' >Alpine Animal Hospital<\/option><option value='2130' >Alpine Veterinary Clinic<\/option><option value='2131' >Alsager Animal Care Center<\/option><option value='2132' >Anchor Bay Veterinary Hospital<\/option><option value='2133' >Angel Animal Hospital<\/option><option value='2134' >Animal Advocates Veterinary Hospital<\/option><option value='2135' >Animal Cancer &amp; Imaging Center<\/option><option value='2136' >Animal Care Clinic-Inkster<\/option><option value='2137' >Animal Care Hospital of Livonia<\/option><option value='2138' >Animal Clinic East<\/option><option value='2139' >Animal Clinic of Sterling Heights<\/option><option value='2140' >Animal Friends Vet Care<\/option><option value='2141' >Animal Health Associates<\/option><option value='2142' >Animal Health Care of North Branch<\/option><option value='2143' >Animal Health Clinic<\/option><option value='2144' >Animal Hospital Maple Orchard<\/option><option value='2145' >Animal Hospital Of Chesterfield<\/option><option value='2146' >Animal Hospital of Kentwood<\/option><option value='2147' >Animal Hospital of Lakeport<\/option><option value='2148' >Animal Kingdom Veterinary Hospital<\/option><option value='2149' >Animal Medical Center of Lapeer<\/option><option value='2150' >Animal Medical Center of Saline<\/option><option value='2151' >Animal Medical Center of Troy<\/option><option value='2152' >Animal Medical Center of Van Buren<\/option><option value='2153' >Animal Surgical Center of Michigan<\/option><option value='2154' >Animal Welfare Society<\/option><option value='2155' >Ann Arbor Animal Hospital<\/option><option value='2156' >APAWS Veterinary Hospital<\/option><option value='2157' >Arbor Hills Animal Clinic<\/option><option value='2158' >Arbor Pointe Veterinary Hosp.<\/option><option value='2159' >Arbor View Veterinary Hospital<\/option><option value='2160' >Ark Animal Clinic<\/option><option value='2161' >Ark Veterinary Hospital<\/option><option value='2162' >Ash Veterinary Clinic<\/option><option value='2163' >Auburn Animal Hospital<\/option><option value='2164' >Avon Animal Clinic<\/option><option value='2165' >B.C. Home Vet Care<\/option><option value='2166' >Bad Axe Animal Medical Clinic<\/option><option value='2167' >Banfield Pet Hospital &#8211; Chesterfield Township<\/option><option value='2168' >Banfield Pet Hospital &#8211; Livonia<\/option><option value='2169' >Banfield Pet Hospital &#8211; Northville<\/option><option value='2170' >Banfield Pet Hospital &#8211; Rochester Hills<\/option><option value='2171' >Banfield Pet Hospital &#8211; Roseville<\/option><option value='2172' >Banfield Pet Hospital &#8211; Southfield<\/option><option value='2173' >Banfield Pet Hospital &#8211; Troy<\/option><option value='2174' >Banfield Pet Hospital &#8211; Utica<\/option><option value='2175' >Banfield Pet Hospital &#8211; Waterford<\/option><option value='2176' >Banfield Pet Hospital &#8211; Woodhaven<\/option><option value='2177' >Bay Valley Animal Hospital<\/option><option value='2178' >Baylis Animal Hospital<\/option><option value='2179' >Bell Veterinary Clinic-Metamora<\/option><option value='2180' >Bell Veterinary Clinic-Oxford<\/option><option value='2181' >Bergmans Veterinary Clinic<\/option><option value='2182' >Berkley Animal Hospital<\/option><option value='2183' >Beverly Hills Veterinary Associates<\/option><option value='2184' >Black River Veterinary Clinic<\/option><option value='2185' >Bloom Animal Hospital<\/option><option value='2186' >Bloomfield Animal Hospital<\/option><option value='2187' >Bloomfield Pointe Animal Hospital<\/option><option value='2188' >Blue Cross Animal Hospital<\/option><option value='2189' >Blue Paws Animal Hospital<\/option><option value='2190' >Blue Pearl Auburn Hills<\/option><option value='2191' >Blue Pearl Neurology Farmington<\/option><option value='2192' >BluePearl Ann Arbor<\/option><option value='2193' >BluePearl Grand Rapids<\/option><option value='2194' >Bluepearl Southfield<\/option><option value='2195' >Branton Animal Clinic<\/option><option value='2196' >Breckenridge Veterinary<\/option><option value='2197' >Briarpoint Veterinary Clinic<\/option><option value='2198' >Briarwood Veterinary Hospital<\/option><option value='2199' >Brinker Veterinary Hospital<\/option><option value='2200' >Brooks Animal Clinic<\/option><option value='2201' >Brown County Veterinary Service<\/option><option value='2202' >Burrwood Veterinary<\/option><option value='2203' >Burtchville Veterinary Clinic<\/option><option value='2204' >Cahill Veterinary Hospital<\/option><option value='2205' >Cambridge Animal Clinic<\/option><option value='2206' >Cameron Medical Center<\/option><option value='2207' >Canton Animal Hospital<\/option><option value='2208' >Canton Center Animal Hosp.<\/option><option value='2209' >Care Veterinary Services<\/option><option value='2210' >Caro Veterinary Clinic<\/option><option value='2211' >Carousel Cat Clinic<\/option><option value='2212' >Caseville Small Animal Clinic<\/option><option value='2213' >cat<\/option><option value='2214' >Cat Care of Rochester Hills<\/option><option value='2215' >Cats Veterinary<\/option><option value='2216' >Cedar Animal Hospital<\/option><option value='2217' >Cedar Creek Veterinary Clnic<\/option><option value='2218' >Centerline Veterinary Hospital<\/option><option value='2219' >Cherry Bend Animal Hospital VCA<\/option><option value='2220' >Cherry Hill Animal Clinic<\/option><option value='2221' >Childs Veterinary Clinic<\/option><option value='2222' >Clarkston Animal Medical Center<\/option><option value='2223' >Clarkston Veterinary Clinic<\/option><option value='2224' >Clio Animal Hospital<\/option><option value='2225' >Commerce Animal Hospital<\/option><option value='2226' >Commerce Village Veterinary Hospital<\/option><option value='2227' >Companion Animal Care Clinic<\/option><option value='2228' >Companion Animal Hospital &#8211; Linden<\/option><option value='2229' >Compassionate Care Animal Hospital<\/option><option value='2230' >Cottonwood Veterinary Clinic<\/option><option value='2231' >Creekside Animal Hospital<\/option><option value='2232' >Croswell Veterinary Service<\/option><option value='2233' >D&#039;Adamo Veterinary Hospital<\/option><option value='2234' >Daley Road Animal Care<\/option><option value='2235' >Dandy Acres Animal Hospital<\/option><option value='2236' >Dearborn Family Pet Care<\/option><option value='2237' >Deporre Veterinary Hosp.<\/option><option value='2238' >Dine Veterinary Hospital<\/option><option value='2239' >Dix Animal Hospital<\/option><option value='2240' >Doc McStuffin Pet Clinic<\/option><option value='2241' >Dogwood Veterinary Referral Center &#8211; Blue Pearl<\/option><option value='2242' >Donaldson Animal Hospital<\/option><option value='2243' >Downtown Birmingham Veterinary<\/option><option value='2244' >Dr. Fitz&#039;s Bayside Animal Clinic<\/option><option value='2245' >Dr. John Herman Mobile Vet<\/option><option value='2246' >Dunckel Veterinary Clinic<\/option><option value='2247' >Dworkis Dog and Cat Hospital<\/option><option value='2248' >East Detroit Animal Hospital<\/option><option value='2249' >East Lansing Veterinary Clinic<\/option><option value='2250' >Eastpointe Animal Hospital<\/option><option value='2251' >Eastside Veterinary Hospital<\/option><option value='2252' >Elk Rapids Animal Hospital<\/option><option value='2253' >Emergency Veterinary Hospital-Ann Arbor<\/option><option value='2254' >Exclusively Cats Veterinary Hospital<\/option><option value='2255' >Faithful Friends Veterinary Care<\/option><option value='2256' >Family Paws Veterinary<\/option><option value='2257' >Family Pet Practice of Waterford<\/option><option value='2258' >Family Pet Practice Wixom<\/option><option value='2259' >Family Pet Practice-Wixom<\/option><option value='2260' >Fenton Veterinary Clinic<\/option><option value='2261' >Ford Caputo Animal Hospital<\/option><option value='2262' >Forest Glade Animal Hospital<\/option><option value='2263' >Fowlerville Veterinary Clinic<\/option><option value='2264' >Fox Run Animal Hospital<\/option><option value='2265' >Francis Animal Hospital<\/option><option value='2266' >Garden City Veterinary Hospital<\/option><option value='2267' >Gasow Veterinary Hospital<\/option><option value='2268' >Gibraltar Veterinary Hospital<\/option><option value='2269' >Gladwin Veterinary Hospital<\/option><option value='2270' >Goodison Veterinary Center, P.C.<\/option><option value='2271' >Grand Blanc Veterinary Hospital<\/option><option value='2272' >Grand River Veterinary Hosp.<\/option><option value='2273' >Great Lakes Animal Hospital<\/option><option value='2274' >Greenfield Veterinary Hospital<\/option><option value='2275' >Greenwood Veterinary Associates PC<\/option><option value='2276' >Griffith Veterinary Hospital Westland<\/option><option value='2277' >Griffith Veterinary Hospital Whitmore Lake<\/option><option value='2278' >Groesbeck Animal Hospital<\/option><option value='2279' >Grosse Pointe Animal Clinic<\/option><option value='2280' >Gull Lake Animal Hospital<\/option><option value='2281' >Hamilton Animal Hospital<\/option><option value='2282' >Harper Woods Veterinary Hospital<\/option><option value='2283' >Hartrick Veterinary Clinic<\/option><option value='2284' >Harvey Animal Hospital<\/option><option value='2285' >Haslett Animal Hospital<\/option><option value='2286' >Healing Care Animal Hospital<\/option><option value='2287' >Healthy Paws Veterinary Medical Center<\/option><option value='2288' >Heritage Vet Hospital<\/option><option value='2289' >Hidden Springs Veterinary Clinic<\/option><option value='2290' >Highland Veterinary Hospital<\/option><option value='2291' >Hilldale Veterinary Hospital<\/option><option value='2292' >Hilton Veterinary Clinic<\/option><option value='2293' >Hollow Corners Veterinary Services<\/option><option value='2294' >Home-Vet<\/option><option value='2295' >Hometown Veterinary Hospital<\/option><option value='2296' >Hoover Road Animal Hospital<\/option><option value='2297' >Hurley Dog and Cat Hospital<\/option><option value='2298' >Huron Veterinary Clinic<\/option><option value='2299' >Imlay City Veterinary Clinic<\/option><option value='2300' >In the Pink Veterinary Clinic\/Cobblestone<\/option><option value='2301' >Indian River Veterinary Clinic<\/option><option value='2302' >Irons Animal Hospital<\/option><option value='2303' >Ithica Animal Hospital<\/option><option value='2304' >Jefferson Veterinary Clinic<\/option><option value='2305' >Jeffrey Animal Hospital<\/option><option value='2306' >Kelly Veterinary Clinic<\/option><option value='2307' >Kimball Animal Hospital<\/option><option value='2308' >Kitty&#039;s Doctor<\/option><option value='2309' >Koprowski Veterinary Clinic<\/option><option value='2310' >Krause Veterinary Clinic<\/option><option value='2311' >LaFond Veterinary Hosp.<\/option><option value='2312' >Lake Huron Veterinary Clinic<\/option><option value='2313' >Lake Orion Veterinary Hospital<\/option><option value='2314' >Lakeside Animal Hospital<\/option><option value='2315' >Lakeville Animal Clinic<\/option><option value='2316' >Laursen Veterinary Service<\/option><option value='2317' >Leader Dogs for the Blind<\/option><option value='2318' >Levan Road Veterinary Hospital<\/option><option value='2319' >Lilley Veterinary Medical Center<\/option><option value='2320' >Lincoln Park Veterinary<\/option><option value='2321' >Lisner Animal Hospital<\/option><option value='2322' >Little Friends of Ferndale<\/option><option value='2323' >Livingston Veterinary Clinic<\/option><option value='2324' >Livonia Veterinary Hospital<\/option><option value='2325' >Long Lake Animal Hospital<\/option><option value='2326' >Luv-N-Care Animal Hospital<\/option><option value='2327' >Macomb Center Veterinary Hosp.<\/option><option value='2328' >Macomb Humane Society<\/option><option value='2329' >Macomb Veterinary Associates<\/option><option value='2330' >MACS Veterinary Clinic (Michigan Anti-Cruelty Society)<\/option><option value='2331' >Madison Veterinary Hospital<\/option><option value='2332' >Maple Grove Veterinary Clinic<\/option><option value='2333' >Maple Veterinary Hospital<\/option><option value='2334' >Marysville Veterinary Clinic<\/option><option value='2335' >Meadowbrook Animal Clinic<\/option><option value='2336' >Meadowbrook Veterinary Clinic<\/option><option value='2337' >MedVet<\/option><option value='2338' >Metropolitan Veterinary Center<\/option><option value='2339' >Michigan Animal Hospital Livernois<\/option><option value='2340' >Michigan Avenue Animal Hospital<\/option><option value='2341' >Michigan Humane &#8211; Detroit &#8211; Grosfeld Veterinary Center<\/option><option value='2342' >Michigan Humane &#8211; Livingston &#8211; Center for Animal Care<\/option><option value='2343' >Michigan Humane &#8211; Rochester Hills &#8211; Center for Animal Care<\/option><option value='2344' >Michigan Humane &#8211; Westland &#8211; Berman Center for Animal Care<\/option><option value='2345' >Michigan State University Veterinary Medical Center<\/option><option value='2346' >MidMichigan Veterinary Hospital<\/option><option value='2347' >Midtown Animal Hospital<\/option><option value='2348' >Milford Veterinary Clinic PC<\/option><option value='2349' >Milwood Animal Clinic<\/option><option value='2350' >MiVet Animal Clinic<\/option><option value='2351' >Monroe Veterinary Clinic<\/option><option value='2352' >Moore Veterinary Hospital<\/option><option value='2353' >Morris Hospital for Veterinary Services<\/option><option value='2354' >Morrison Animal Hospital<\/option><option value='2355' >MSU Veterinary Center<\/option><option value='2356' >Mt Pleasant Animal Hospital, P.C<\/option><option value='2357' >Mt. Pleasant Animal Hospital<\/option><option value='2519' >My 2nd New Vet<\/option><option value='2105' >My New Vet<\/option><option value='2358' >Natural Healing Pet Care<\/option><option value='2359' >Nichols Veterinary Clinic<\/option><option value='2361' >North Main Animal Hospital<\/option><option value='2362' >North River Animal Hospital<\/option><option value='2363' >North Suburban Veterinary Hosp<\/option><option value='2364' >Northland Veterinary Clinic<\/option><option value='2365' >Northville Animal Hospital<\/option><option value='2366' >Northwest Veterinary Clinic, PC<\/option><option value='2367' >Not Known<\/option><option value='2368' >Novi Veterinary Clinic<\/option><option value='2369' >Nucci Veterinary Hospital<\/option><option value='2370' >Oakland Animal Hospital<\/option><option value='2371' >Oakland Hills Veterinary<\/option><option value='2372' >Oakland Veterinary Referral Services<\/option><option value='2373' >Oakwood Veterinary Hospital<\/option><option value='2374' >Orchard Lake Animal Hospital<\/option><option value='2375' >Orchard Maple Vet Clinic<\/option><option value='2376' >Orion Animal Care Center<\/option><option value='2377' >Orion Animal Hospital<\/option><option value='2378' >Orion Oaks Animal Hospital<\/option><option value='2379' >Ortonville Animal Clinic<\/option><option value='2380' >Ovid-Elsie Animal Clinic<\/option><option value='2381' >Oxford Animal Clinic<\/option><option value='2382' >Paint Creek Animal Clinic<\/option><option value='2383' >Parker Veterinary Hospital<\/option><option value='2384' >Parkview Animal Hospital<\/option><option value='2385' >Parkway Veterinary Clinic &#8211; Plymouth<\/option><option value='2386' >Parkway Veterinary Hospital<\/option><option value='2387' >Patterson Dog &amp; Cat Hospital (Detroit)<\/option><option value='2388' >Patterson Veterinary Hospital<\/option><option value='2389' >Pawsitive Care Vet Clinic<\/option><option value='2390' >Pawsitive Steps Rehab<\/option><option value='2391' >Pet Authority Animal Hospital<\/option><option value='2392' >Pet Care Clinic<\/option><option value='2393' >Pet Doctor<\/option><option value='2394' >PetCare Plus<\/option><option value='2395' >Pets Ahoy Animal Hospital<\/option><option value='2396' >PetSmart Veterinary Services<\/option><option value='2397' >PetWellClinic Royal Oak<\/option><option value='2398' >Pierson Pet Hospital<\/option><option value='2399' >Platz Animal Hospital<\/option><option value='2400' >Plaza Veterinary Hospital<\/option><option value='2401' >Plymouth Beech Animal Hospital<\/option><option value='2402' >Plymouth Veterinary Hosp.<\/option><option value='2403' >Pointe Animal Hospital<\/option><option value='2404' >Poppy Hill Vet<\/option><option value='2405' >Pytel Veterinary Clinic<\/option><option value='2406' >Red Barn Veterinary Medical Center<\/option><option value='2407' >Reliance Animal Hospital<\/option><option value='2408' >Remrock Farms<\/option><option value='2409' >Richmond Veterinary Clinic<\/option><option value='2410' >Riverfront Animal Hospital<\/option><option value='2411' >Riverside Animal Hospital<\/option><option value='2412' >Riverside Cat Hospital<\/option><option value='2413' >Riverview Veterinary Center<\/option><option value='2414' >Roadside Veterinary Clinic<\/option><option value='2415' >Rochester Veterinary Hospital<\/option><option value='2416' >Romeo Veterinary Hospital<\/option><option value='2417' >Roose Animal Hospital<\/option><option value='2418' >Rosedale Veterinary Housecalls: Begnigna Andrew A DVM<\/option><option value='2419' >Ross Hospital for Animals<\/option><option value='2420' >Rossoni Animal Hospital<\/option><option value='2421' >Royal Oak Animal Hospital<\/option><option value='2422' >Salem Veterinary Services<\/option><option value='2423' >Schultz Veterinary Clinic<\/option><option value='2424' >Serenity Animal Hospital<\/option><option value='2425' >Sharp Animal Hospital<\/option><option value='2426' >Sheehy Animal Hospital<\/option><option value='2427' >Shelby Veterinary Hospital<\/option><option value='2428' >Sheldon Veterinary Hospital<\/option><option value='2429' >Sheppard Alternative Animal Care<\/option><option value='2430' >Snider Veterinary Services PC<\/option><option value='2431' >Snyder Veterinary Clinic<\/option><option value='2432' >Somerset Veterinary Hospital<\/option><option value='2433' >South Arbor Animal Hospital<\/option><option value='2434' >South Lyon Animal Clinic<\/option><option value='2435' >South Shore Animal Hospital<\/option><option value='2436' >Southfield Veterinary Hospital<\/option><option value='2437' >Southgate Animal Hospital<\/option><option value='2438' >Southpoint Veterinary Hosp.<\/option><option value='2439' >Spartan Veterinary Clinic<\/option><option value='2440' >Springfield Veterinary Clinic<\/option><option value='2441' >St. Clair Bed &amp; Bone<\/option><option value='2442' >St. Francis Animal Hospital<\/option><option value='2443' >St. Julian&#039;s Cat Care<\/option><option value='2444' >Stadium Veterinary Services<\/option><option value='2445' >Stony Creek Veterinary Hospital<\/option><option value='2446' >Strong Village Veterinary Center<\/option><option value='2447' >Strong Village Veterinary Hospital<\/option><option value='2448' >Surrey Veterinary Clinic<\/option><option value='2449' >Tail Waggers<\/option><option value='2450' >Taylor Veterinary Clinic<\/option><option value='2451' >Tecumseh Animal Hospital<\/option><option value='2452' >The Kitty Clinic<\/option><option value='2453' >Thomson Animal Clinic<\/option><option value='2454' >Thorpe Animal Hospital<\/option><option value='2455' >Towne &amp; Country Animal Hospital<\/option><option value='2456' >Troy &amp; Heights Animal Hospital<\/option><option value='2457' >Troy Veterinary Hospital<\/option><option value='2458' >TruHeal Veterinary Hospital<\/option><option value='2459' >Union Lake Veterinary Clinic<\/option><option value='2460' >Unleashed Pet Care<\/option><option value='2461' >VCA Allen Park Animal Hospital<\/option><option value='2462' >VCA Animal Hospital of Garden City<\/option><option value='2463' >VCA Beech Road Animal Hospital<\/option><option value='2464' >VCA Clinton Township Animal Hospital<\/option><option value='2465' >VCA Countryside Animal Hospital of Hamburg<\/option><option value='2466' >VCA Countryside Animal Hospital of Howell<\/option><option value='2467' >VCA Farmington Hills Animal Hospital<\/option><option value='2468' >VCA Southland Animal Hospital<\/option><option value='2469' >VCA St. Clair Shores Animal Hospital<\/option><option value='2470' >VCA Swartz Creek Animal Hospital<\/option><option value='2471' >VCA White Lake Animal Hospital<\/option><option value='2472' >VCA Woodland Animal Hospital<\/option><option value='2473' >VES West<\/option><option value='2474' >Vet IQ Petcare in Meijer &#8211; Warren<\/option><option value='2475' >Vetco Total Care<\/option><option value='2476' >Veterinary Associates, LLC<\/option><option value='2477' >Veterinary Cardiology Consultants &#8211; Novi<\/option><option value='2478' >Veterinary Cardiology Consultants &#8211; Rochester<\/option><option value='2479' >Veterinary Care Center of Richmond<\/option><option value='2480' >Veterinary Care Services of Milford<\/option><option value='2481' >Veterinary Emergency Service<\/option><option value='2482' >Veterinary General<\/option><option value='2483' >Veterinary Health Center<\/option><option value='2484' >Veterinary House Calls<\/option><option value='2485' >Veterinary Vision of Rochester<\/option><option value='2486' >VetIQ Petcare Royal Oak<\/option><option value='2487' >Vets2U<\/option><option value='2488' >VetSelect Animal Hospital of Commerce<\/option><option value='2489' >VetSelect Animal Hospital of Dearborn<\/option><option value='2490' >VetSelect Animal Hospital of Novi<\/option><option value='2491' >Village Animal Healthcare<\/option><option value='2492' >Wadhams Road Animal Care Center<\/option><option value='2493' >Walled Lake Veterinary Hospital<\/option><option value='2494' >Warren Animal Clinic<\/option><option value='2495' >Warren Woods Veterinary Hospital<\/option><option value='2496' >Waterford Animal Clinic<\/option><option value='2497' >West Arbor Veterinary Hospital<\/option><option value='2498' >West Bloomfield Veterinary Hospital<\/option><option value='2499' >West Branch Veterinary Services<\/option><option value='2500' >West Flint Animal Hospital<\/option><option value='2501' >West Warren Veterinary<\/option><option value='2502' >West Woodward Animal Clinic<\/option><option value='2503' >Westland Veterinary Hospital<\/option><option value='2504' >Westside Veterinary Hospital<\/option><option value='2505' >Westwood Hills Animal Hospital<\/option><option value='2506' >Wilson Veterinary Hospital<\/option><option value='2507' >Woodhaven Animal Hospital<\/option><option value='2508' >Woodland Animal Hospital<\/option><option value='2509' >Woodward Veterinary Home Care<\/option><option value='2510' >Wyandotte Animal Hospital<\/option><option value='2511' >Yale Veterinary Hospital<\/option><option value='other' >Other<\/option><\/select><\/div><\/div><div id=\"field_4_6\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_6'>Vet Match<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_4_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_23\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Vet Match Details<\/h3><div class='gsection_description' id='gfield_description_4_23'>\n<\/div><\/div><div id=\"field_4_7\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_7'>Street Address<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_4_7' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_9\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_9'>City<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_4_9' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_10\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_10'>State<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_4_10' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_11'>Zip<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_4_11' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_12\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_12'>Email<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_4_12' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_13\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_13'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_4_13' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_14\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_14'>Website<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_4_14' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_22'>Country<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_4_22' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_15\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Add New Vet<\/h3><div class='gsection_description' id='gfield_description_4_15'>Add a new vet business to our database.  Enter your vet&#8217;s business name, address, phone number and email address.\n<\/div><\/div><div id=\"field_4_16\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_16'>Vet Business Name<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_4_16' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_18\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Vet Business Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_4_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_4_18_1' value=''    aria-required='false'    \/>\n                                        <label for='input_4_18_1' id='input_4_18_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_4_18_3' value=''    aria-required='false'    \/>\n                                    <label for='input_4_18_3' id='input_4_18_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_4_18_4_container' >\n                                        <input type='text' name='input_18.4' id='input_4_18_4' value=''      aria-required='false'    \/>\n                                        <label for='input_4_18_4' id='input_4_18_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_4_18_5' value=''    aria-required='false'    \/>\n                                    <label for='input_4_18_5' id='input_4_18_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_4_18_6_container' >\n                                        <select name='input_18.6' id='input_4_18_6'   aria-required='false'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' 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#001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Pet Intake Form<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/index.php\/wp-json\/wp\/v2\/pages\/468' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_105\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_105'>LinkedIn<\/label><div class='ginput_container'><input name='input_105' id='input_5_105' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_5_105'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_5_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_1'>\n                            \n                            <span id='input_5_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_5_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_5_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_6\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_5_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_6_1' id='input_5_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_5_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_6_3' id='input_5_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_6_4_container' >\n                                        <select name='input_6.4' id='input_5_6_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_6_4' id='input_5_6_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_5_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_6_5' id='input_5_6_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_5_6_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_10\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_10'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_5_10' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_79'>\n\t\t\t<div class='gchoice gchoice_5_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Home'  id='choice_5_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_79_0' id='label_5_79_0' class='gform-field-label gform-field-label--type-inline'>Home<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Cell'  id='choice_5_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_79_1' id='label_5_79_1' class='gform-field-label gform-field-label--type-inline'>Cell<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_8\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_5_8_container'>\n                                <span id='input_5_8_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_8' id='input_5_8' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_5_8' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_5_8_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_8_2' id='input_5_8_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_5_8_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_5_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you the owner of this pet?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_5'>\n\t\t\t<div class='gchoice gchoice_5_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Yes'  id='choice_5_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_5_0' id='label_5_5_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='No'  id='choice_5_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_5_1' id='label_5_5_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_4\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_4'>What is your relationship to this pet?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_5_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_61\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_61' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_61_1_container' >\n                                        <input type='text' name='input_61.1' id='input_5_61_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_61_1' id='input_5_61_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_61_3_container' >\n                                    <input type='text' name='input_61.3' id='input_5_61_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_61_3' id='input_5_61_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_61_4_container' >\n                                        <input type='text' name='input_61.4' id='input_5_61_4' value=''      aria-required='true'    \/>\n                                        <label for='input_5_61_4' id='input_5_61_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_61_5_container' >\n                                    <input type='text' name='input_61.5' id='input_5_61_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_61_5' id='input_5_61_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_61.6' id='input_5_61_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_62\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_62'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_62' id='input_5_62' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_63\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_5_63_container'>\n                                <span id='input_5_63_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_63' id='input_5_63' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_5_63' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_5_63_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_63_2' id='input_5_63_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_5_63_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_5_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Has this pet been here before?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_16'>\n\t\t\t<div class='gchoice gchoice_5_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes'  id='choice_5_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_16_0' id='label_5_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No'  id='choice_5_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_16_1' id='label_5_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='I&#039;m not sure'  id='choice_5_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_16_2' id='label_5_16_2' class='gform-field-label gform-field-label--type-inline'>I'm not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_17\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Secondary Contact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_17'>\n                            \n                            <span id='input_5_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_5_17_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_17_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_5_17_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_17_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_19\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_19'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_5_19' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_20'><div class='gchoice gchoice_5_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Home'  id='choice_5_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_20_1' id='label_5_20_1' class='gform-field-label gform-field-label--type-inline'>Home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Cell'  id='choice_5_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_20_2' id='label_5_20_2' class='gform-field-label gform-field-label--type-inline'>Cell<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_21\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_21'>Reason for today&#039;s visit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_5_21' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_22\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Patient (Pet) Information<\/h3><\/div><div id=\"field_5_23\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_23'>Pet&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_5_23' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_72\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_72'>Upload a picture of your pet.  This is optional.<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_72' id='input_5_72' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_72\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_72'>Max. file size: 512 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_72'><\/div> <\/div><\/div><fieldset id=\"field_5_59\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Species<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_59'>\n\t\t\t<div class='gchoice gchoice_5_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Dog'  id='choice_5_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_59_0' id='label_5_59_0' class='gform-field-label gform-field-label--type-inline'>Dog<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Cat'  id='choice_5_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_59_1' id='label_5_59_1' class='gform-field-label gform-field-label--type-inline'>Cat<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_54'>\n\t\t\t<div class='gchoice gchoice_5_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Male'  id='choice_5_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_54_0' id='label_5_54_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Female'  id='choice_5_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_54_1' id='label_5_54_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Unsure'  id='choice_5_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_54_2' id='label_5_54_2' class='gform-field-label gform-field-label--type-inline'>Unsure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Breeding Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_31'>\n\t\t\t<div class='gchoice gchoice_5_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Spayed'  id='choice_5_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_31_0' id='label_5_31_0' class='gform-field-label gform-field-label--type-inline'>Spayed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Fully Functional'  id='choice_5_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_31_1' id='label_5_31_1' class='gform-field-label gform-field-label--type-inline'>Fully Functional<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Breeding Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_55'>\n\t\t\t<div class='gchoice gchoice_5_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Neutered'  id='choice_5_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_0' id='label_5_55_0' class='gform-field-label gform-field-label--type-inline'>Neutered<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Fully Functional'  id='choice_5_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_55_1' id='label_5_55_1' class='gform-field-label gform-field-label--type-inline'>Fully Functional<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_25\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_25'>Breed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_5_25' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Mixed Breed' >Mixed Breed<\/option><option value='Affenpinscher' >Affenpinscher<\/option><option value='Afghan Hound' >Afghan Hound<\/option><option value='Airedale Terrier' >Airedale Terrier<\/option><option value='Akita' >Akita<\/option><option value='Alaskan Malamute' >Alaskan Malamute<\/option><option value='American Bulldog' >American Bulldog<\/option><option value='American Eskimo' >American Eskimo<\/option><option value='American Foxhound' >American Foxhound<\/option><option value='Australian Cattle Dog' >Australian Cattle Dog<\/option><option value='Australian Shepherd' >Australian Shepherd<\/option><option value='Australian Terrier' >Australian Terrier<\/option><option value='Basenji' >Basenji<\/option><option value='Basset Hound' >Basset Hound<\/option><option value='Beagle' >Beagle<\/option><option value='Bearded Collie' >Bearded Collie<\/option><option value='Bernese Mountain Dog' >Bernese Mountain Dog<\/option><option value='Bichon Frise' >Bichon Frise<\/option><option value='Black Russian Terrier' >Black Russian Terrier<\/option><option value='Bloodhound' >Bloodhound<\/option><option value='Border Collie' >Border Collie<\/option><option value='Border Terrier' >Border Terrier<\/option><option value='Borzoi' >Borzoi<\/option><option value='Boston Terrier' >Boston Terrier<\/option><option value='Bouvier des Flandres' >Bouvier des Flandres<\/option><option value='Boxer' >Boxer<\/option><option value='Briard' >Briard<\/option><option value='Brittany' >Brittany<\/option><option value='Brussels Griffon' >Brussels Griffon<\/option><option value='Bull Terrier' >Bull Terrier<\/option><option value='Bullmastiff' >Bullmastiff<\/option><option value='Cairn Terrier' >Cairn Terrier<\/option><option value='Canaan Dog' >Canaan Dog<\/option><option value='Cane Corso' >Cane Corso<\/option><option value='Cardigan Welsh Corgi' >Cardigan Welsh Corgi<\/option><option value='Cavalier King Charles Spaniel' >Cavalier King Charles Spaniel<\/option><option value='Chesapeake Bay Retriever' >Chesapeake Bay Retriever<\/option><option value='Chihuahua' >Chihuahua<\/option><option value='Chinese Crested' >Chinese Crested<\/option><option value='Chinese Shar-Pei' >Chinese Shar-Pei<\/option><option value='Chow Chow' >Chow Chow<\/option><option value='Clumber Spaniel' >Clumber Spaniel<\/option><option value='Cocker Spaniel' >Cocker Spaniel<\/option><option value='Collie' >Collie<\/option><option value='Corgi' >Corgi<\/option><option value='Curly-Coated Retriever' >Curly-Coated Retriever<\/option><option value='Dachshund' >Dachshund<\/option><option value='Dalmatian' >Dalmatian<\/option><option value='Dandie Dinmont Terrier' >Dandie Dinmont Terrier<\/option><option value='Doberman Pinscher' >Doberman Pinscher<\/option><option value='English Bulldog' >English Bulldog<\/option><option value='English Cocker Spaniel' >English Cocker Spaniel<\/option><option value='English Foxhound' >English Foxhound<\/option><option value='English Setter' >English Setter<\/option><option value='English Springer Spaniel' >English Springer Spaniel<\/option><option value='English Toy Spaniel' >English Toy Spaniel<\/option><option value='Entlebucher Mountain Dog' >Entlebucher Mountain Dog<\/option><option value='Field Spaniel' >Field Spaniel<\/option><option value='Finnish Lapphund' >Finnish Lapphund<\/option><option value='Finnish Spitz' >Finnish Spitz<\/option><option value='Flat-Coated Retriever' >Flat-Coated Retriever<\/option><option value='French Bulldog' >French Bulldog<\/option><option value='German Pinscher' >German Pinscher<\/option><option value='German Shepherd' >German Shepherd<\/option><option value='German Shorthaired Pointer' >German Shorthaired Pointer<\/option><option value='German Wirehaired Pointer' >German Wirehaired Pointer<\/option><option value='Giant Schnauzer' >Giant Schnauzer<\/option><option value='Golden Retriever' >Golden Retriever<\/option><option value='Gordon Setter' >Gordon Setter<\/option><option value='Great Dane' >Great Dane<\/option><option value='Great Pyrenees' >Great Pyrenees<\/option><option value='Greater Swiss Mountain Dog' >Greater Swiss Mountain Dog<\/option><option value='Greyhound' >Greyhound<\/option><option value='Harrier' >Harrier<\/option><option value='Havanese' >Havanese<\/option><option value='Ibizan Hound' >Ibizan Hound<\/option><option value='Icelandic Sheepdog' >Icelandic Sheepdog<\/option><option value='Irish Red and White Setter' >Irish Red and White Setter<\/option><option value='Irish Setter' >Irish Setter<\/option><option value='Irish Terrier' >Irish Terrier<\/option><option value='Irish Water Spaniel' >Irish Water Spaniel<\/option><option value='Irish Wolfhound' >Irish Wolfhound<\/option><option value='Italian Greyhound' >Italian Greyhound<\/option><option value='Japanese Chin' >Japanese Chin<\/option><option value='Japanese Spitz' >Japanese Spitz<\/option><option value='Keeshond' >Keeshond<\/option><option value='Kerry Blue Terrier' >Kerry Blue Terrier<\/option><option value='Komondor' >Komondor<\/option><option value='Kuvasz' >Kuvasz<\/option><option value='Labrador Retriever' >Labrador Retriever<\/option><option value='Lakeland Terrier' >Lakeland Terrier<\/option><option value='Leonberger' >Leonberger<\/option><option value='Lhasa Apso' >Lhasa Apso<\/option><option value='Lowchen' >Lowchen<\/option><option value='Maltese' >Maltese<\/option><option value='Manchester Terrier' >Manchester Terrier<\/option><option value='Mastiff' >Mastiff<\/option><option value='Miniature Pinscher' >Miniature Pinscher<\/option><option value='Miniature Schnauzer' >Miniature Schnauzer<\/option><option value='Neapolitan Mastiff' >Neapolitan Mastiff<\/option><option value='Newfoundland' >Newfoundland<\/option><option value='Norfolk Terrier' >Norfolk Terrier<\/option><option value='Norwegian Buhund' >Norwegian Buhund<\/option><option value='Norwegian Elkhound' >Norwegian Elkhound<\/option><option value='Norwegian Lundehund' >Norwegian Lundehund<\/option><option value='Old English Sheepdog' >Old English Sheepdog<\/option><option value='Otterhound' >Otterhound<\/option><option value='Papillon' >Papillon<\/option><option value='Pekingese' >Pekingese<\/option><option value='Pembroke Welsh Corgi' >Pembroke Welsh Corgi<\/option><option value='Petit Basset Griffon Vendeen' >Petit Basset Griffon Vendeen<\/option><option value='Pharaoh Hound' >Pharaoh Hound<\/option><option value='Pointer' >Pointer<\/option><option value='Pomeranian' >Pomeranian<\/option><option value='Poodle (Miniature)' >Poodle (Miniature)<\/option><option value='Poodle (Standard)' >Poodle (Standard)<\/option><option value='Poodle (Toy)' >Poodle (Toy)<\/option><option value='Portuguese Podengo' >Portuguese Podengo<\/option><option value='Portuguese Water Dog' >Portuguese Water Dog<\/option><option value='Pudelpointer' >Pudelpointer<\/option><option value='Pug' >Pug<\/option><option value='Pyrenean Mountain Dog' >Pyrenean Mountain Dog<\/option><option value='Rat Terrier' >Rat Terrier<\/option><option value='Redbone Coonhound' >Redbone Coonhound<\/option><option value='Rhodesian Ridgeback' >Rhodesian Ridgeback<\/option><option value='Rottweiler' >Rottweiler<\/option><option value='Saint Bernard' >Saint Bernard<\/option><option value='Saluki' >Saluki<\/option><option value='Samoyed' >Samoyed<\/option><option value='Schipperke' >Schipperke<\/option><option value='Scottish Deerhound' >Scottish Deerhound<\/option><option value='Scottish Terrier' >Scottish Terrier<\/option><option value='Shetland Sheepdog' >Shetland Sheepdog<\/option><option value='Shiba Inu' >Shiba Inu<\/option><option value='Shih Tzu' >Shih Tzu<\/option><option value='Siberian Husky' >Siberian Husky<\/option><option value='Silky Terrier' >Silky Terrier<\/option><option value='Skye Terrier' >Skye Terrier<\/option><option value='Sloughi' >Sloughi<\/option><option value='Smooth Fox Terrier' >Smooth Fox Terrier<\/option><option value='Soft-Coated Wheaten Terrier' >Soft-Coated Wheaten Terrier<\/option><option value='Spanish Water Dog' >Spanish Water Dog<\/option><option value='Spinone Italiano' >Spinone Italiano<\/option><option value='Staffordshire Bull Terrier' >Staffordshire Bull Terrier<\/option><option value='Standard Poodle' >Standard Poodle<\/option><option value='Standard Schnauzer' >Standard Schnauzer<\/option><option value='Sussex Spaniel' >Sussex Spaniel<\/option><option value='Swedish Vallhund' >Swedish Vallhund<\/option><option value='Thai Ridgeback' >Thai Ridgeback<\/option><option value='Tibetan Mastiff' >Tibetan Mastiff<\/option><option value='Toy Fox Terrier' >Toy Fox Terrier<\/option><option value='Treeing Walker Coonhound' >Treeing Walker Coonhound<\/option><option value='Welsh Springer Spaniel' >Welsh Springer Spaniel<\/option><option value='Welsh Terrier' >Welsh Terrier<\/option><option value='West Highland White Terrier' >West Highland White Terrier<\/option><option value='Whippet' >Whippet<\/option><option value='Wire Fox Terrier' >Wire Fox Terrier<\/option><option value='Wirehaired Dachshund' >Wirehaired Dachshund<\/option><option value='Wirehaired Pointing Griffon' >Wirehaired Pointing Griffon<\/option><option value='Xoloitzcuintli' >Xoloitzcuintli<\/option><option value='Yorkshire Terrier' >Yorkshire Terrier<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_5_27\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_27'>Please describe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_5_27' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_71\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_71'>Please describe.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_5_71' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_26\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_26'>Breed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_5_26' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Abyssinian' >Abyssinian<\/option><option value='American Shorthair' >American Shorthair<\/option><option value='Bengal' >Bengal<\/option><option value='Birman' >Birman<\/option><option value='Calico' >Calico<\/option><option value='Devon Rex' >Devon Rex<\/option><option value='Domestic Longhair' >Domestic Longhair<\/option><option value='Domestic Shorthair' >Domestic Shorthair<\/option><option value='Himalayan' >Himalayan<\/option><option value='Maine Coon' >Maine Coon<\/option><option value='Oriental Shorthair' >Oriental Shorthair<\/option><option value='Siamese' >Siamese<\/option><option value='Persian' >Persian<\/option><option value='Ragdoll' >Ragdoll<\/option><option value='Sphynx' >Sphynx<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_5_28\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_28'>Please describe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_5_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you know your pet&#039;s birthday?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_81'>\n\t\t\t<div class='gchoice gchoice_5_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='No'  id='choice_5_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_81_0' id='label_5_81_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Yes'  id='choice_5_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_81_1' id='label_5_81_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_82\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_82'>Pet&#039;s Birthday<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_82' id='input_5_82' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_82_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_82_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_82' class='gform_hidden' value='https:\/\/vet.mattryan.co\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_5_34\" class=\"gfield gfield--type-list gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Years<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Months<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell1 gform-grid-col' data-label='Years'><input aria-invalid='false' aria-required=\"true\"  aria-label='Years, Row 1' data-aria-label-template='Years, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell2 gform-grid-col' data-label='Months'><input aria-invalid='false' aria-required=\"true\"  aria-label='Months, Row 1' data-aria-label-template='Months, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_5_35\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_35'>Color(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_5_35' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Black' >Black<\/option><option value='Brown\/Chocolate\/Liver' >Brown\/Chocolate\/Liver<\/option><option value='Yellow\/Gold\/Tan\/Fawn' >Yellow\/Gold\/Tan\/Fawn<\/option><option value='Red-Coppery or reddish shades' >Red-Coppery or reddish shades<\/option><option value='White' >White<\/option><option value='Blue\/Grey\/Silver' >Blue\/Grey\/Silver<\/option><option value='Brindle' >Brindle<\/option><option value='Merle' >Merle<\/option><option value='Bicolor\/Tricolor' >Bicolor\/Tricolor<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_5_90\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_90'>Please describe.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_5_90' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_36\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_36'>Color(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_5_36' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Black' >Black<\/option><option value='Blue\/Grey' >Blue\/Grey<\/option><option value='Red\/Orange\/Ginger' >Red\/Orange\/Ginger<\/option><option value='White' >White<\/option><option value='Cream' >Cream<\/option><option value='Brown\/Chocolate' >Brown\/Chocolate<\/option><option value='Cinnamon\/Fawn' >Cinnamon\/Fawn<\/option><option value='Tabby Patterns' >Tabby Patterns<\/option><option value='Tortoiseshell' >Tortoiseshell<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_5_91\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_91'>Please describe.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_5_91' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_38\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_38'>Special Markings<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_5_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_58\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_58'>Who is your regular veterinarian?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_58' id='input_5_58' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select a Vet<\/option><option value='765' >5 Mile Vet<\/option><option value='766' >9-Tel Animal Hospital<\/option><option value='767' >A W Animal Hospital<\/option><option value='768' >A-Care Animal Clinic<\/option><option value='769' >A-Quality Care Veterinary Hospital<\/option><option value='770' >Ace Animal Clinic<\/option><option value='771' >Advanced Animal Emergency<\/option><option value='772' >Advanced Pet Care of Oakland<\/option><option value='773' >Advanced Veterinary Care Group Canton<\/option><option value='774' >Advanced Veterinary Medical Group<\/option><option value='775' >AEC Novi<\/option><option value='776' >AEC Rochester<\/option><option value='777' >Affiliated Veterinary Emergency Service<\/option><option value='778' >Affordable Veterinary Care Center<\/option><option value='779' >Airport Veterinary Hosp.<\/option><option value='780' >Alexis Road Animal Hospital<\/option><option value='781' >Alfa Animal Care-Farmington Hills<\/option><option value='782' >Alfa Animal Care-Sterling Heights<\/option><option value='783' >All About Animals<\/option><option value='784' >All Creatures Veterinary Services<\/option><option value='785' >Allen Animal Hospital<\/option><option value='786' >Almont-Dryden Veterinary Hospital<\/option><option value='787' >Alpine Animal Hospital<\/option><option value='788' >Alpine Veterinary Clinic<\/option><option value='789' >Alsager Animal Care Center<\/option><option value='790' >Anchor Bay Veterinary Hospital<\/option><option value='791' >Angel Animal Hospital<\/option><option value='792' >Animal Advocates Veterinary Hospital<\/option><option value='793' >Animal Cancer &amp; Imaging Center<\/option><option value='794' >Animal Care Clinic-Inkster<\/option><option value='795' >Animal Care Hospital of Livonia<\/option><option value='796' >Animal Clinic East<\/option><option value='797' >Animal Clinic of Sterling Heights<\/option><option value='798' >Animal Friends Vet Care<\/option><option value='799' >Animal Health Associates<\/option><option value='800' >Animal Health Care of North Branch<\/option><option value='801' >Animal Health Clinic<\/option><option value='802' >Animal Hospital Maple Orchard<\/option><option value='803' >Animal Hospital Of Chesterfield<\/option><option value='804' >Animal Hospital of Kentwood<\/option><option value='805' >Animal Hospital of Lakeport<\/option><option value='806' >Animal Kingdom Veterinary Hospital<\/option><option value='807' >Animal Medical Center of Lapeer<\/option><option value='808' >Animal Medical Center of Saline<\/option><option value='809' >Animal Medical Center of Troy<\/option><option value='810' >Animal Medical Center of Van Buren<\/option><option value='811' >Animal Surgical Center of Michigan<\/option><option value='812' >Animal Welfare Society<\/option><option value='813' >Ann Arbor Animal Hospital<\/option><option value='814' >APAWS Veterinary Hospital<\/option><option value='815' >Arbor Hills Animal Clinic<\/option><option value='816' >Arbor Pointe Veterinary Hosp.<\/option><option value='817' >Arbor View Veterinary Hospital<\/option><option value='818' >Ark Animal Clinic<\/option><option value='819' >Ark Veterinary Hospital<\/option><option value='820' >Ash Veterinary Clinic<\/option><option value='821' >Auburn Animal Hospital<\/option><option value='822' >Avon Animal Clinic<\/option><option value='823' >B.C. Home Vet Care<\/option><option value='824' >Bad Axe Animal Medical Clinic<\/option><option value='825' >Banfield Pet Hospital - Chesterfield Township<\/option><option value='826' >Banfield Pet Hospital - Livonia<\/option><option value='827' >Banfield Pet Hospital - Northville<\/option><option value='828' >Banfield Pet Hospital - Rochester Hills<\/option><option value='829' >Banfield Pet Hospital - Roseville<\/option><option value='830' >Banfield Pet Hospital - Southfield<\/option><option value='831' >Banfield Pet Hospital - Troy<\/option><option value='832' >Banfield Pet Hospital - Utica<\/option><option value='833' >Banfield Pet Hospital - Waterford<\/option><option value='834' >Banfield Pet Hospital - Woodhaven<\/option><option value='835' >Bay Valley Animal Hospital<\/option><option value='836' >Baylis Animal Hospital<\/option><option value='837' >Bell Veterinary Clinic-Metamora<\/option><option value='838' >Bell Veterinary Clinic-Oxford<\/option><option value='839' >Bergmans Veterinary Clinic<\/option><option value='840' >Berkley Animal Hospital<\/option><option value='841' >Beverly Hills Veterinary Associates<\/option><option value='842' >Black River Veterinary Clinic<\/option><option value='843' >Bloom Animal Hospital<\/option><option value='844' >Bloomfield Animal Hospital<\/option><option value='845' >Bloomfield Pointe Animal Hospital<\/option><option value='846' >Blue Cross Animal Hospital<\/option><option value='847' >Blue Paws Animal Hospital<\/option><option value='848' >Blue Pearl Auburn Hills<\/option><option value='849' >Blue Pearl Neurology Farmington<\/option><option value='850' >BluePearl Ann Arbor<\/option><option value='851' >BluePearl Grand Rapids<\/option><option value='852' >Bluepearl Southfield<\/option><option value='853' >Branton Animal Clinic<\/option><option value='854' >Breckenridge Veterinary<\/option><option value='855' >Briarpoint Veterinary Clinic<\/option><option value='856' >Briarwood Veterinary Hospital<\/option><option value='857' >Brinker Veterinary Hospital<\/option><option value='858' >Brooks Animal Clinic<\/option><option value='859' >Brown County Veterinary Service<\/option><option value='860' >Burrwood Veterinary<\/option><option value='861' >Burtchville Veterinary Clinic<\/option><option value='862' >Cahill Veterinary Hospital<\/option><option value='863' >Cambridge Animal Clinic<\/option><option value='864' >Cameron Medical Center<\/option><option value='865' >Canton Animal Hospital<\/option><option value='866' >Canton Center Animal Hosp.<\/option><option value='867' >Care Veterinary Services<\/option><option value='868' >Caro Veterinary Clinic<\/option><option value='869' >Carousel Cat Clinic<\/option><option value='870' >Caseville Small Animal Clinic<\/option><option value='871' >cat<\/option><option value='872' >Cat Care of Rochester Hills<\/option><option value='873' >Cats Veterinary<\/option><option value='874' >Cedar Animal Hospital<\/option><option value='875' >Cedar Creek Veterinary Clnic<\/option><option value='876' >Centerline Veterinary Hospital<\/option><option value='877' >Cherry Bend Animal Hospital VCA<\/option><option value='878' >Cherry Hill Animal Clinic<\/option><option value='879' >Childs Veterinary Clinic<\/option><option value='880' >Clarkston Animal Medical Center<\/option><option value='881' >Clarkston Veterinary Clinic<\/option><option value='882' >Clio Animal Hospital<\/option><option value='883' >Commerce Animal Hospital<\/option><option value='884' >Commerce Village Veterinary Hospital<\/option><option value='885' >Companion Animal Care Clinic<\/option><option value='886' >Companion Animal Hospital - Linden<\/option><option value='887' >Compassionate Care Animal Hospital<\/option><option value='888' >Cottonwood Veterinary Clinic<\/option><option value='889' >Creekside Animal Hospital<\/option><option value='890' >Croswell Veterinary Service<\/option><option value='891' >D&#039;Adamo Veterinary Hospital<\/option><option value='892' >Daley Road Animal Care<\/option><option value='893' >Dandy Acres Animal Hospital<\/option><option value='894' >Dearborn Family Pet Care<\/option><option value='895' >Deporre Veterinary Hosp.<\/option><option value='896' >Dine Veterinary Hospital<\/option><option value='897' >Dix Animal Hospital<\/option><option value='898' >Doc McStuffin Pet Clinic<\/option><option value='899' >Dogwood Veterinary Referral Center - Blue Pearl<\/option><option value='900' >Donaldson Animal Hospital<\/option><option value='901' >Downtown Birmingham Veterinary<\/option><option value='902' >Dr. Fitz&#039;s Bayside Animal Clinic<\/option><option value='903' >Dr. John Herman Mobile Vet<\/option><option value='904' >Dunckel Veterinary Clinic<\/option><option value='905' >Dworkis Dog and Cat Hospital<\/option><option value='906' >East Detroit Animal Hospital<\/option><option value='907' >East Lansing Veterinary Clinic<\/option><option value='908' >Eastpointe Animal Hospital<\/option><option value='909' >Eastside Veterinary Hospital<\/option><option value='910' >Elk Rapids Animal Hospital<\/option><option value='911' >Emergency Veterinary Hospital-Ann Arbor<\/option><option value='912' >Exclusively Cats Veterinary Hospital<\/option><option value='913' >Faithful Friends Veterinary Care<\/option><option value='914' >Family Paws Veterinary<\/option><option value='915' >Family Pet Practice of Waterford<\/option><option value='916' >Family Pet Practice Wixom<\/option><option value='917' >Family Pet Practice-Wixom<\/option><option value='918' >Fenton Veterinary Clinic<\/option><option value='919' >Ford Caputo Animal Hospital<\/option><option value='920' >Forest Glade Animal Hospital<\/option><option value='921' >Fowlerville Veterinary Clinic<\/option><option value='922' >Fox Run Animal Hospital<\/option><option value='923' >Francis Animal Hospital<\/option><option value='924' >Garden City Veterinary Hospital<\/option><option value='925' >Gasow Veterinary Hospital<\/option><option value='926' >Gibraltar Veterinary Hospital<\/option><option value='927' >Gladwin Veterinary Hospital<\/option><option value='928' >Goodison Veterinary Center, P.C.<\/option><option value='929' >Grand Blanc Veterinary Hospital<\/option><option value='930' >Grand River Veterinary Hosp.<\/option><option value='931' >Great Lakes Animal Hospital<\/option><option value='932' >Greenfield Veterinary Hospital<\/option><option value='933' >Greenwood Veterinary Associates PC<\/option><option value='934' >Griffith Veterinary Hospital Westland<\/option><option value='935' >Griffith Veterinary Hospital Whitmore Lake<\/option><option value='936' >Groesbeck Animal Hospital<\/option><option value='937' >Grosse Pointe Animal Clinic<\/option><option value='938' >Gull Lake Animal Hospital<\/option><option value='939' >Hamilton Animal Hospital<\/option><option value='940' >Harper Woods Veterinary Hospital<\/option><option value='941' >Hartrick Veterinary Clinic<\/option><option value='942' >Harvey Animal Hospital<\/option><option value='943' >Haslett Animal Hospital<\/option><option value='944' >Healing Care Animal Hospital<\/option><option value='945' >Healthy Paws Veterinary Medical Center<\/option><option value='946' >Heritage Vet Hospital<\/option><option value='947' >Hidden Springs Veterinary Clinic<\/option><option value='948' >Highland Veterinary Hospital<\/option><option value='949' >Hilldale Veterinary Hospital<\/option><option value='950' >Hilton Veterinary Clinic<\/option><option value='951' >Hollow Corners Veterinary Services<\/option><option value='952' >Home-Vet<\/option><option value='953' >Hometown Veterinary Hospital<\/option><option value='954' >Hoover Road Animal Hospital<\/option><option value='955' >Hurley Dog and Cat Hospital<\/option><option value='956' >Huron Veterinary Clinic<\/option><option value='957' >Imlay City Veterinary Clinic<\/option><option value='958' >In the Pink Veterinary Clinic\/Cobblestone<\/option><option value='959' >Indian River Veterinary Clinic<\/option><option value='960' >Irons Animal Hospital<\/option><option value='961' >Ithica Animal Hospital<\/option><option value='962' >Jefferson Veterinary Clinic<\/option><option value='963' >Jeffrey Animal Hospital<\/option><option value='1601' >Joe the Vet<\/option><option value='964' >Kelly Veterinary Clinic<\/option><option value='965' >Kimball Animal Hospital<\/option><option value='966' >Kitty&#039;s Doctor<\/option><option value='967' >Koprowski Veterinary Clinic<\/option><option value='968' >Krause Veterinary Clinic<\/option><option value='969' >LaFond Veterinary Hosp.<\/option><option value='970' >Lake Huron Veterinary Clinic<\/option><option value='971' >Lake Orion Veterinary Hospital<\/option><option value='972' >Lakeside Animal Hospital<\/option><option value='973' >Lakeville Animal Clinic<\/option><option value='974' >Laursen Veterinary Service<\/option><option value='975' >Leader Dogs for the Blind<\/option><option value='976' >Levan Road Veterinary Hospital<\/option><option value='977' >Lilley Veterinary Medical Center<\/option><option value='978' >Lincoln Park Veterinary<\/option><option value='979' >Lisner Animal Hospital<\/option><option value='980' >Little Friends of Ferndale<\/option><option value='981' >Livingston Veterinary Clinic<\/option><option value='982' >Livonia Veterinary Hospital<\/option><option value='983' >Long Lake Animal Hospital<\/option><option value='984' >Luv-N-Care Animal Hospital<\/option><option value='985' >Macomb Center Veterinary Hosp.<\/option><option value='986' >Macomb Humane Society<\/option><option value='987' >Macomb Veterinary Associates<\/option><option value='988' >MACS Veterinary Clinic (Michigan Anti-Cruelty Society)<\/option><option value='989' >Madison Veterinary Hospital<\/option><option value='990' >Maple Grove Veterinary Clinic<\/option><option value='991' >Maple Veterinary Hospital<\/option><option value='992' >Marysville Veterinary Clinic<\/option><option value='993' >Meadowbrook Animal Clinic<\/option><option value='994' >Meadowbrook Veterinary Clinic<\/option><option value='995' >MedVet<\/option><option value='996' >Metropolitan Veterinary Center<\/option><option value='997' >Michigan Animal Hospital Livernois<\/option><option value='998' >Michigan Avenue Animal Hospital<\/option><option value='999' >Michigan Humane - Detroit - Grosfeld Veterinary Center<\/option><option value='1000' >Michigan Humane - Livingston - Center for Animal Care<\/option><option value='1001' >Michigan Humane - Rochester Hills - Center for Animal Care<\/option><option value='1002' >Michigan Humane - Westland - Berman Center for Animal Care<\/option><option value='1003' >Michigan State University Veterinary Medical Center<\/option><option value='1004' >MidMichigan Veterinary Hospital<\/option><option value='1005' >Midtown Animal Hospital<\/option><option value='1006' >Milford Veterinary Clinic PC<\/option><option value='1007' >Milwood Animal Clinic<\/option><option value='1008' >MiVet Animal Clinic<\/option><option value='1009' >Monroe Veterinary Clinic<\/option><option value='1010' >Moore Veterinary Hospital<\/option><option value='1011' >Morris Hospital for Veterinary Services<\/option><option value='1012' >Morrison Animal Hospital<\/option><option value='1013' >MSU Veterinary Center<\/option><option value='1014' >Mt Pleasant Animal Hospital, P.C<\/option><option value='1015' >Mt. Pleasant Animal Hospital<\/option><option value='1016' >Natural Healing Pet Care<\/option><option value='1604' >New Documented Vet<\/option><option value='1614' >New VETER<\/option><option value='1017' >Nichols Veterinary Clinic<\/option><option value='1019' >North Main Animal Hospital<\/option><option value='1020' >North River Animal Hospital<\/option><option value='1021' >North Suburban Veterinary Hosp<\/option><option value='1022' >Northland Veterinary Clinic<\/option><option value='1023' >Northville Animal Hospital<\/option><option value='1024' >Northwest Veterinary Clinic, PC<\/option><option value='1025' >Not Known<\/option><option value='1026' >Novi Veterinary Clinic<\/option><option value='1027' >Nucci Veterinary Hospital<\/option><option value='1028' >Oakland Animal Hospital<\/option><option value='1029' >Oakland Hills Veterinary<\/option><option value='1030' >Oakland Veterinary Referral Services<\/option><option value='1031' >Oakwood Veterinary Hospital<\/option><option value='1032' >Orchard Lake Animal Hospital<\/option><option value='1033' >Orchard Maple Vet Clinic<\/option><option value='1034' >Orion Animal Care Center<\/option><option value='1035' >Orion Animal Hospital<\/option><option value='1036' >Orion Oaks Animal Hospital<\/option><option value='1037' >Ortonville Animal Clinic<\/option><option value='1038' >Ovid-Elsie Animal Clinic<\/option><option value='1039' >Oxford Animal Clinic<\/option><option value='1040' >Paint Creek Animal Clinic<\/option><option value='1041' >Parker Veterinary Hospital<\/option><option value='1042' >Parkview Animal Hospital<\/option><option value='1043' >Parkway Veterinary Clinic - Plymouth<\/option><option value='1044' >Parkway Veterinary Hospital<\/option><option value='1045' >Patterson Dog &amp; Cat Hospital (Detroit)<\/option><option value='1046' >Patterson Veterinary Hospital<\/option><option value='1047' >Pawsitive Care Vet Clinic<\/option><option value='1048' >Pawsitive Steps Rehab<\/option><option value='1049' >Pet Authority Animal Hospital<\/option><option value='1050' >Pet Care Clinic<\/option><option value='1051' >Pet Doctor<\/option><option value='1052' >PetCare Plus<\/option><option value='1053' >Pets Ahoy Animal Hospital<\/option><option value='1054' >PetSmart Veterinary Services<\/option><option value='1055' >PetWellClinic Royal Oak<\/option><option value='1056' >Pierson Pet Hospital<\/option><option value='1057' >Platz Animal Hospital<\/option><option value='1058' >Plaza Veterinary Hospital<\/option><option value='1059' >Plymouth Beech Animal Hospital<\/option><option value='1060' >Plymouth Veterinary Hosp.<\/option><option value='1061' >Pointe Animal Hospital<\/option><option value='1062' >Poppy Hill Vet<\/option><option value='1063' >Pytel Veterinary Clinic<\/option><option value='1064' >Red Barn Veterinary Medical Center<\/option><option value='1065' >Reliance Animal Hospital<\/option><option value='1066' >Remrock Farms<\/option><option value='1067' >Richmond Veterinary Clinic<\/option><option value='1068' >Riverfront Animal Hospital<\/option><option value='1069' >Riverside Animal Hospital<\/option><option value='1070' >Riverside Cat Hospital<\/option><option value='1071' >Riverview Veterinary Center<\/option><option value='1072' >Roadside Veterinary Clinic<\/option><option value='1073' >Rochester Veterinary Hospital<\/option><option value='1074' >Romeo Veterinary Hospital<\/option><option value='1075' >Roose Animal Hospital<\/option><option value='1076' >Rosedale Veterinary Housecalls: Begnigna Andrew A DVM<\/option><option value='1077' >Ross Hospital for Animals<\/option><option value='1078' >Rossoni Animal Hospital<\/option><option value='1079' >Royal Oak Animal Hospital<\/option><option value='1080' >Salem Veterinary Services<\/option><option value='1081' >Schultz Veterinary Clinic<\/option><option value='1082' >Serenity Animal Hospital<\/option><option value='1083' >Sharp Animal Hospital<\/option><option value='1084' >Sheehy Animal Hospital<\/option><option value='1085' >Shelby Veterinary Hospital<\/option><option value='1086' >Sheldon Veterinary Hospital<\/option><option value='1087' >Sheppard Alternative Animal Care<\/option><option value='1088' >Snider Veterinary Services PC<\/option><option value='1089' >Snyder Veterinary Clinic<\/option><option value='1090' >Somerset Veterinary Hospital<\/option><option value='1091' >South Arbor Animal Hospital<\/option><option value='1092' >South Lyon Animal Clinic<\/option><option value='1093' >South Shore Animal Hospital<\/option><option value='1094' >Southfield Veterinary Hospital<\/option><option value='1095' >Southgate Animal Hospital<\/option><option value='1096' >Southpoint Veterinary Hosp.<\/option><option value='1097' >Spartan Veterinary Clinic<\/option><option value='1098' >Springfield Veterinary Clinic<\/option><option value='1099' >St. Clair Bed &amp; Bone<\/option><option value='1100' >St. Francis Animal Hospital<\/option><option value='1101' >St. Julian&#039;s Cat Care<\/option><option value='1102' >Stadium Veterinary Services<\/option><option value='1103' >Stony Creek Veterinary Hospital<\/option><option value='1104' >Strong Village Veterinary Center<\/option><option value='1105' >Strong Village Veterinary Hospital<\/option><option value='1106' >Surrey Veterinary Clinic<\/option><option value='1107' >Tail Waggers<\/option><option value='1108' >Taylor Veterinary Clinic<\/option><option value='1109' >Tecumseh Animal Hospital<\/option><option value='1593' >Test New Vet 5\/11<\/option><option value='1110' >The Kitty Clinic<\/option><option value='1111' >Thomson Animal Clinic<\/option><option value='1112' >Thorpe Animal Hospital<\/option><option value='1113' >Towne &amp; Country Animal Hospital<\/option><option value='1114' >Troy &amp; Heights Animal Hospital<\/option><option value='1115' >Troy Veterinary Hospital<\/option><option value='1116' >TruHeal Veterinary Hospital<\/option><option value='1117' >Union Lake Veterinary Clinic<\/option><option value='1118' >Unleashed Pet Care<\/option><option value='1119' >VCA Allen Park Animal Hospital<\/option><option value='1120' >VCA Animal Hospital of Garden City<\/option><option value='1121' >VCA Beech Road Animal Hospital<\/option><option value='1122' >VCA Clinton Township Animal Hospital<\/option><option value='1123' >VCA Countryside Animal Hospital of Hamburg<\/option><option value='1124' >VCA Countryside Animal Hospital of Howell<\/option><option value='1125' >VCA Farmington Hills Animal Hospital<\/option><option value='1126' >VCA Southland Animal Hospital<\/option><option value='1127' >VCA St. Clair Shores Animal Hospital<\/option><option value='1128' >VCA Swartz Creek Animal Hospital<\/option><option value='1129' >VCA White Lake Animal Hospital<\/option><option value='1130' >VCA Woodland Animal Hospital<\/option><option value='1131' >VES West<\/option><option value='1132' >Vet IQ Petcare in Meijer - Warren<\/option><option value='1133' >Vetco Total Care<\/option><option value='1134' >Veterinary Associates, LLC<\/option><option value='1135' >Veterinary Cardiology Consultants - Novi<\/option><option value='1136' >Veterinary Cardiology Consultants - Rochester<\/option><option value='1137' >Veterinary Care Center of Richmond<\/option><option value='1138' >Veterinary Care Services of Milford<\/option><option value='1139' >Veterinary Emergency Service<\/option><option value='1140' >Veterinary General<\/option><option value='1141' >Veterinary Health Center<\/option><option value='1142' >Veterinary House Calls<\/option><option value='1143' >Veterinary Vision of Rochester<\/option><option value='1144' >VetIQ Petcare Royal Oak<\/option><option value='1145' >Vets2U<\/option><option value='1146' >VetSelect Animal Hospital of Commerce<\/option><option value='1147' >VetSelect Animal Hospital of Dearborn<\/option><option value='1148' >VetSelect Animal Hospital of Novi<\/option><option value='1149' >Village Animal Healthcare<\/option><option value='1150' >Wadhams Road Animal Care Center<\/option><option value='1151' >Walled Lake Veterinary Hospital<\/option><option value='1152' >Warren Animal Clinic<\/option><option value='1153' >Warren Woods Veterinary Hospital<\/option><option value='1154' >Waterford Animal Clinic<\/option><option value='763' >wefrwer<\/option><option value='1155' >West Arbor Veterinary Hospital<\/option><option value='1156' >West Bloomfield Veterinary Hospital<\/option><option value='1157' >West Branch Veterinary Services<\/option><option value='1158' >West Flint Animal Hospital<\/option><option value='1159' >West Warren Veterinary<\/option><option value='1160' >West Woodward Animal Clinic<\/option><option value='1161' >Westland Veterinary Hospital<\/option><option value='1162' >Westside Veterinary Hospital<\/option><option value='1163' >Westwood Hills Animal Hospital<\/option><option value='1164' >Wilson Veterinary Hospital<\/option><option value='1165' >Woodhaven Animal Hospital<\/option><option value='1166' >Woodland Animal Hospital<\/option><option value='1599' >Woodland Animal Hospital<\/option><option value='1167' >Woodward Veterinary Home Care<\/option><option value='1168' >Wyandotte Animal Hospital<\/option><option value='1169' >Yale Veterinary Hospital<\/option><option value='other' >Other<\/option><\/select><\/div><\/div><div id=\"field_5_102\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_102'>Vet Match<\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_5_102' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_92\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">Vet Match Details<\/h3><\/div><div id=\"field_5_93\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_93'>Street Address<\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_5_93' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_94\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_94'>City<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_5_94' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_95\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_95'>State<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_5_95' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_96\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_96'>Zip<\/label><div class='ginput_container ginput_container_text'><input name='input_96' id='input_5_96' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_97\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_97'>Email<\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_5_97' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_98\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_98'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_5_98' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_99\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_99'>Website<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_5_99' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_100\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_100'>Country<\/label><div class='ginput_container ginput_container_text'><input name='input_100' id='input_5_100' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_84\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Please provide us your vet&#039;s contact information.<\/h3><\/div><div id=\"field_5_85\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_85'>Vet Business Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_5_85' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_86\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Vet Business Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_5_86' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_86_1_container' >\n                                        <input type='text' name='input_86.1' id='input_5_86_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_86_1' id='input_5_86_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_86_3_container' >\n                                    <input type='text' name='input_86.3' id='input_5_86_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_86_3' id='input_5_86_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_86_4_container' >\n                                        <input type='text' name='input_86.4' id='input_5_86_4' value=''      aria-required='false'    \/>\n                                        <label for='input_5_86_4' id='input_5_86_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_86_5_container' >\n                                    <input type='text' name='input_86.5' id='input_5_86_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_86_5' id='input_5_86_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_5_86_6_container' >\n                                        <select name='input_86.6' id='input_5_86_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_5_86_6' id='input_5_86_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_87\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_87'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_87' id='input_5_87' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_88\" class=\"gfield gfield--type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_88'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_88' id='input_5_88' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_89\" class=\"gfield gfield--type-website gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_89'>Website<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_89' id='input_5_89' type='url' value='' class='medium'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_5_104\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_5_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I authorize the release of my pet&#039;s complete medical records to any requesting veterinary clinic.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_70'>\n\t\t\t<div class='gchoice gchoice_5_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_5_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_70_0' id='label_5_70_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_5_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_70_1' id='label_5_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_101\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_101'>DO NOT RELEASE ANY MEDICAL RECORDS to ANY REQUESTING VETERINARY CLINIC<\/label><div class='ginput_container ginput_container_text'><input name='input_101' id='input_5_101' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Does your pet have any history of aggression<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_39'>\n\t\t\t<div class='gchoice gchoice_5_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Yes'  id='choice_5_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_39_0' id='label_5_39_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='No'  id='choice_5_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_39_1' id='label_5_39_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please check all that apply.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_67'><div class='gchoice gchoice_5_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='Animal aggression'  id='choice_5_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_1' id='label_5_67_1' class='gform-field-label gform-field-label--type-inline'>Animal aggression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='Human aggression'  id='choice_5_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_2' id='label_5_67_2' class='gform-field-label gform-field-label--type-inline'>Human aggression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.3' type='checkbox'  value='Needs muzzle - will bite'  id='choice_5_67_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_3' id='label_5_67_3' class='gform-field-label gform-field-label--type-inline'>Needs muzzle - will bite<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.4' type='checkbox'  value='Sensitive body parts'  id='choice_5_67_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_4' id='label_5_67_4' class='gform-field-label gform-field-label--type-inline'>Sensitive body parts<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.5' type='checkbox'  value='Nervousness'  id='choice_5_67_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_5' id='label_5_67_5' class='gform-field-label gform-field-label--type-inline'>Nervousness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.6' type='checkbox'  value='Has there been any prior incident(s) at a veterinary clinic that required sedation?'  id='choice_5_67_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_6' id='label_5_67_6' class='gform-field-label gform-field-label--type-inline'>Has there been any prior incident(s) at a veterinary clinic that required sedation?<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.7' type='checkbox'  value='Other'  id='choice_5_67_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_7' id='label_5_67_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_66\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_66'>Please note sensitive body parts.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_5_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_40\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_40'>Please describe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_40' id='input_5_40' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_5_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have pet insurance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_41'>\n\t\t\t<div class='gchoice gchoice_5_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Yes'  id='choice_5_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_41_0' id='label_5_41_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='No'  id='choice_5_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_41_1' id='label_5_41_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please tell us who your provider is.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_73'>\n\t\t\t<div class='gchoice gchoice_5_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Pet Assure'  id='choice_5_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_0' id='label_5_73_0' class='gform-field-label gform-field-label--type-inline'>Pet Assure<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Lemonade'  id='choice_5_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_1' id='label_5_73_1' class='gform-field-label gform-field-label--type-inline'>Lemonade<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Fetch'  id='choice_5_73_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_2' id='label_5_73_2' class='gform-field-label gform-field-label--type-inline'>Fetch<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Trupanion'  id='choice_5_73_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_3' id='label_5_73_3' class='gform-field-label gform-field-label--type-inline'>Trupanion<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Nationwide'  id='choice_5_73_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_4' id='label_5_73_4' class='gform-field-label gform-field-label--type-inline'>Nationwide<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Spot'  id='choice_5_73_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_5' id='label_5_73_5' class='gform-field-label gform-field-label--type-inline'>Spot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Pet&#039;s Best'  id='choice_5_73_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_6' id='label_5_73_6' class='gform-field-label gform-field-label--type-inline'>Pet's Best<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Metlife'  id='choice_5_73_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_7' id='label_5_73_7' class='gform-field-label gform-field-label--type-inline'>Metlife<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Pumpkin'  id='choice_5_73_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_8' id='label_5_73_8' class='gform-field-label gform-field-label--type-inline'>Pumpkin<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='AKC Pet Insurance'  id='choice_5_73_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_9' id='label_5_73_9' class='gform-field-label gform-field-label--type-inline'>AKC Pet Insurance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Banfield Optimum Wellness'  id='choice_5_73_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_10' id='label_5_73_10' class='gform-field-label gform-field-label--type-inline'>Banfield Optimum Wellness<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_73_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Other'  id='choice_5_73_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_73_11' id='label_5_73_11' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_42\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_42'>Who is your provider?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_5_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_43\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_43'>How did you hear about our clinic?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_5_43' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Drove By' >Drove By<\/option><option value='Google' >Google<\/option><option value='Online Presence' >Online Presence<\/option><option value='Social Media' >Social Media<\/option><option value='Friend or Family Member' >Friend or Family Member<\/option><option value='Physical Event' >Physical Event<\/option><option value='Veterinarian' >Veterinarian<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_5_44\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_44'>Please describe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_5_44' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_45\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Terms of Service<\/h3><\/div><fieldset id=\"field_5_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >The emergency exam fee is $90.00.  All diagnostics, medications, and treatments are additional to the exam fee.  An estimate for additional services and medications will be provided and you will have the opportunity to approve or decline and recommendations.  Payment is due in full at the time of services rendered.  We do not offer any form of billing.  We accept all major credit cards, Cherry payment plan, Care Credit, ApplePay and cash.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_46'><div class='gchoice gchoice_5_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='I agree.'  id='choice_5_46_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_1' id='label_5_46_1' class='gform-field-label gform-field-label--type-inline'>I agree.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_51\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Information and\/or photos may be used for teaching, continuing education, website, veterinary literature, promotional materials, and the like.  I authorize the release of case\/patient information for such purposes; pet owner confidentiality will be maintained.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_51'><div class='gchoice gchoice_5_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='I agree.'  id='choice_5_51_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_51_1' id='label_5_51_1' class='gform-field-label gform-field-label--type-inline'>I agree.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_57\" class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_57' id='input_5_57_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_5_57_Container' class='gfield_signature_container' style='height:180px; width:1000px; ' ><canvas id=\"input_5_57\" width=\"1000\" height=\"180\" style=\"border-style: solid; border-width: 2px; border-color: #00f; background-color:#FFFFFF; cursor: url(https:\/\/vet.mattryan.co\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><\/div><div id='input_5_57_toolbar' style='margin:5px 0;position:relative;height:20px;width:1000px;max-width:100%;'><img id='input_5_57_resetbutton' src='data:image\/png;base64,iVBORw0KGgoAAAANSUhEUgAAABgAAAAYCAYAAADgdz34AAAAGXRFWHRTb2Z0d2FyZQBBZG9iZSBJbWFnZVJlYWR5ccllPAAAAtRJREFUeNrsld9rklEYx32nc7i2GulGtZg6XJbJyBeJzbGZJJVuAyFD7D8QumiG7nLXQuw6dtHN7oYwFtIgDG+2CGQtGf1grBpWIkPHaDpJZvZ95F2cqfPHRTfRgY\/H85znfb7nPc85z8sVi0XR32zcf4GmBTiOk8GWY8YSdEpwHpwG7eAA\/ABJsA3\/w5MEJOUGi8VyCUFFeCiGvlcsFvOFQqGtzK1d4Bzmr8DvDfy\/NyTgcDj6I5GIGA91YdiN4CW7RqNp83g8fZ2dna17e3v5ubm5r1tbWz8F8WH4v4PIh7oCTOumH4VCIQkGg6axsTElgkRhyoJTXq\/33srKStzpdL5KpVK0RVcxvw+Rb40KlNr09LTSbDZH8HcJ\/DqyY2sksE9Go1GHVqsN5fP5Yk9Pz3WIJNmctNQT8Pl8n\/DQZza40CjIokqlerywsMCTYWdnpwVjTb0kF1dXVy2sLR6Pn4HIJnu6mLZht9s3KUeUE7VarYPt459ZOqZlKMFEFRRVfI+QzMzMeBHOOTAw4GbnKt4AK6Vte0\/nHA6pBu\/T4ejoqAgnS4dTlT82U74aJOourYTn+ds1VlyNm+AReMjaK5LsdrvpxoqSyWSX8DbVSwDHtYJ+hi9gETxl\/SoCWK1WGfWJRKLQ0dGhO0kAq5MGAoFB\/OVZXC6XtqYAzvamwWCgMiDK5XKXsSL5CRpZv98vnp+fH2SNJpPpYk0BlIIXSJaB\/lOZkEqlNyCi4ahAHd8iajGUj41a2a+2xzmj0fgsFAoN0QA3lAJfAxMISDeVpx7jSbJnMplSOZ6amuptVIBaZHx8\/G0sFruj1+tlgo2KWh\/oF3opGWl+bW3t1uzsrHJ5eXm42Q+OGW\/wADc7gYe3w+Fwen19\/YByhMMgt9lsqpGRkQvYxifwfQnup9PprFwuX2rmi0ZvYAdDwurPgl1A9ek1eE7byqYR7P873+TfAgwATQiKdubVli0AAAAASUVORK5CYII=' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' role='button' tabindex='0' aria-label='Clear Signature' \/><\/div><input type='hidden' id='input_5_57_data' name='input_5_57_data' value=''><\/div><\/div><\/fieldset><div id=\"field_5_75\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">No Refund Policy Notice<\/h3><\/div><fieldset id=\"field_5_77\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I understand that all veterinary services rendered, including exams, diagnostics, treatments, and procedures, are non-refundable once performed. I also acknowledge that all medications dispensed or administered are non-refundable. By signing below, I accept full financial responsibility for all approved services and products.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_77'><div class='gchoice gchoice_5_77_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.1' type='checkbox'  value='I agree.'  id='choice_5_77_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_77_1' id='label_5_77_1' class='gform-field-label gform-field-label--type-inline'>I agree.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_76\" class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_76' id='input_5_76_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_5_76_Container' class='gfield_signature_container' style='height:180px; width:1000px; ' ><canvas id=\"input_5_76\" width=\"1000\" height=\"180\" style=\"border-style: solid; border-width: 2px; border-color: #00f; background-color:#FFFFFF; cursor: url(https:\/\/vet.mattryan.co\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><\/div><div id='input_5_76_toolbar' style='margin:5px 0;position:relative;height:20px;width:1000px;max-width:100%;'><img id='input_5_76_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' role='button' tabindex='0' aria-label='Clear Signature' \/><\/div><input type='hidden' id='input_5_76_data' name='input_5_76_data' value=''><\/div><\/div><\/fieldset><div id=\"field_5_53\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_53'>Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_53' id='input_5_53' type='text' value='06\/05\/2026' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' 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