VETERINARY · CONTACT FORM TEMPLATE

Veterinarian Appointment Request Form

Vet appointment requests need pet species, age, and symptom — a 'my dog is throwing up' form that doesn't capture species sends the wrong tech in the wrong room.

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form.htmlhtml52 lines

01<form action="https://splitforms.com/api/submit" method="POST">
02  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
03  <input type="hidden" name="subject" value="New vet appointment request">
04 
05  <label for="owner_name">Owner name *</label>
06  <input id="owner_name" type="text" name="owner_name" placeholder="Sofia Reis" required>
07  <label for="email">Email *</label>
08  <input id="email" type="email" name="email" placeholder="sofia@example.com" required>
09  <label for="phone">Phone *</label>
10  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
11  <label for="pet_name">Pet name *</label>
12  <input id="pet_name" type="text" name="pet_name" placeholder="Biscuit" required>
13  <label for="species">Species *</label>
14  <select id="species" name="species" required>
15    <option value="">Choose…</option>
16    <option>Dog</option>
17    <option>Cat</option>
18    <option>Rabbit</option>
19    <option>Bird</option>
20    <option>Reptile</option>
21    <option>Other</option>
22  </select>
23  <label for="breed">Breed</label>
24  <input id="breed" type="text" name="breed" placeholder="Tabby">
25  <label for="age">Age</label>
26  <input id="age" type="text" name="age" placeholder="3 years">
27  <label for="reason">Reason for visit *</label>
28  <select id="reason" name="reason" required>
29    <option value="">Choose…</option>
30    <option>Annual checkup</option>
31    <option>Vaccinations</option>
32    <option>Sick visit</option>
33    <option>Dental</option>
34    <option>Surgery consultation</option>
35    <option>Spay / neuter</option>
36    <option>Emergency</option>
37    <option>Other</option>
38  </select>
39  <label for="preferred_date">Preferred date *</label>
40  <input id="preferred_date" type="date" name="preferred_date" required>
41  <label for="symptoms">Symptoms / details</label>
42  <textarea id="symptoms" name="symptoms" placeholder="When it started, eating habits, behavior changes…"></textarea>
43 
44  <!-- honeypot — bots fill every field -->
45  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">
46 
47  <button type="submit">Send</button>
48</form>
49 
50<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
51  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
52</p>

1,000

submissions / mo, free

fields, ready to ship

code outputs

60s

from copy to inbox

Veterinarian Appointment Request Form — example splitforms template with submissions inbox

§ 01Why it mattersthe qualifying-fields argument

Vet practices schedule by species — small-animal vs exotics vs equine each need different exam rooms and tech setups. The form's first field is 'pet type' (dog / cat / rabbit / bird / reptile / other). Add age, symptom or reason, and weight if known — that's enough for the front desk to slot the appointment correctly. Emergency cases (lethargy, vomiting blood, hit-by-car) trigger a same-day urgent slot or a referral to the local 24-hour ER vet.

✦ at a glance

→Veterinary appointment · 10 fields
→HTML, JS, React, PHP, cURL outputs
→One POST endpoint, no SDK
→Honeypot + classifier, no CAPTCHA

§ 02Live previewinteractive · sandboxed · no key required

See exactly what your visitors see — and you’ll receive.

Left: the rendered form, fully interactive in a sandboxed iframe. Right: the email and dashboard view that lands the moment a visitor submits.

preview · veterinarian-contact-formlocalhost:3000

✦ what you’ll see in your inbox

Every submission becomes an email plus a dashboard row. The fields below are the exact payload your form will send. Reply-to is wired to the visitor’s email so hitting reply goes back to them.

dashboard · new submission14ms · 200 OK

SUBJECT · New vet appointment request

Owner name: Maya Iyer
Email: maya@studio71.co
Phone: +1 415 555 0142
Pet name: Maya Iyer
Species: Dog
Breed: —
Age: —
Reason for visit: Annual checkup
Preferred date: 2026-05-15
Symptoms / details: —

Iframe is sandboxed — submit doesn’t actually fire. Get your access key to wire it up live.

§ 03Three steps3 steps · ~60 seconds

Generate, embed, receive.

Three actions stand between you and your first lead. None of them require a backend, a database, or a CAPTCHA library.

STEP 01GENERATE

Capture pet and symptom

Required: pet species, breed if known, age, weight (approx), reason for visit (wellness / vaccinations / sick / emergency / surgery).

Create your form

key=sk_live_••••••••

STEP 02EMBED

Triage by urgency

Symptoms like vomiting, lethargy, breathing trouble auto-flag urgent. Webhook routes to the front desk's urgent inbox; non-urgent goes to the standard scheduling queue.

snippethtml

<form action="https://splitforms.com/api/submit" method="POST">
  …
</form>

STEP 03RECEIVE

Send pre-visit reminders

Webhook to your reminder system with the appointment confirmation, fasting instructions if surgery, and any vaccine records you need them to bring.

inbox · 1 newjust now

FROM contact@yoursite.com

New vet appointment request

Maya Iyer maya@studio71.co

Loved your last open house in Hayes — looking for similar with parking. Pre-approved through Wells Fargo.

§ 04Copy & ship5 languages · same endpoint

Five outputs. One backend.

HTML by default. Click open the language you ship in — every variant POSTs to the same /api/submit endpoint.

01HTMLform.html52 lines

<form action="https://splitforms.com/api/submit" method="POST">
  <input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
  <input type="hidden" name="subject" value="New vet appointment request">

  <label for="owner_name">Owner name *</label>
  <input id="owner_name" type="text" name="owner_name" placeholder="Sofia Reis" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="sofia@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="pet_name">Pet name *</label>
  <input id="pet_name" type="text" name="pet_name" placeholder="Biscuit" required>
  <label for="species">Species *</label>
  <select id="species" name="species" required>
    <option value="">Choose…</option>
    <option>Dog</option>
    <option>Cat</option>
    <option>Rabbit</option>
    <option>Bird</option>
    <option>Reptile</option>
    <option>Other</option>
  </select>
  <label for="breed">Breed</label>
  <input id="breed" type="text" name="breed" placeholder="Tabby">
  <label for="age">Age</label>
  <input id="age" type="text" name="age" placeholder="3 years">
  <label for="reason">Reason for visit *</label>
  <select id="reason" name="reason" required>
    <option value="">Choose…</option>
    <option>Annual checkup</option>
    <option>Vaccinations</option>
    <option>Sick visit</option>
    <option>Dental</option>
    <option>Surgery consultation</option>
    <option>Spay / neuter</option>
    <option>Emergency</option>
    <option>Other</option>
  </select>
  <label for="preferred_date">Preferred date *</label>
  <input id="preferred_date" type="date" name="preferred_date" required>
  <label for="symptoms">Symptoms / details</label>
  <textarea id="symptoms" name="symptoms" placeholder="When it started, eating habits, behavior changes…"></textarea>

  <!-- honeypot — bots fill every field -->
  <input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">

  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

02JavaScriptform.js68 lines

<form id="lf-form">
  <label for="owner_name">Owner name *</label>
  <input id="owner_name" type="text" name="owner_name" placeholder="Sofia Reis" required>
  <label for="email">Email *</label>
  <input id="email" type="email" name="email" placeholder="sofia@example.com" required>
  <label for="phone">Phone *</label>
  <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required>
  <label for="pet_name">Pet name *</label>
  <input id="pet_name" type="text" name="pet_name" placeholder="Biscuit" required>
  <label for="species">Species *</label>
  <select id="species" name="species" required>
    <option value="">Choose…</option>
    <option>Dog</option>
    <option>Cat</option>
    <option>Rabbit</option>
    <option>Bird</option>
    <option>Reptile</option>
    <option>Other</option>
  </select>
  <label for="breed">Breed</label>
  <input id="breed" type="text" name="breed" placeholder="Tabby">
  <label for="age">Age</label>
  <input id="age" type="text" name="age" placeholder="3 years">
  <label for="reason">Reason for visit *</label>
  <select id="reason" name="reason" required>
    <option value="">Choose…</option>
    <option>Annual checkup</option>
    <option>Vaccinations</option>
    <option>Sick visit</option>
    <option>Dental</option>
    <option>Surgery consultation</option>
    <option>Spay / neuter</option>
    <option>Emergency</option>
    <option>Other</option>
  </select>
  <label for="preferred_date">Preferred date *</label>
  <input id="preferred_date" type="date" name="preferred_date" required>
  <label for="symptoms">Symptoms / details</label>
  <textarea id="symptoms" name="symptoms" placeholder="When it started, eating habits, behavior changes…"></textarea>
  <button type="submit">Send</button>
</form>

<p style="margin-top:12px;font-size:11px;color:#888;text-align:right">
  Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="noopener">splitforms</a>
</p>

<script>
  document.getElementById('lf-form').addEventListener('submit', async (e) => {
    e.preventDefault();
    const data = new FormData(e.target);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New vet appointment request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    if (json.success) {
      e.target.reset();
      alert('Sent!');
    } else {
      alert('Error: ' + (json.message || 'Try again'));
    }
  });
</script>

03React / Next.jsForm.tsx83 lines

'use client';

import { useState, type FormEvent } from 'react';

export default function VetAppointmentForm() {
  const [status, setStatus] = useState<'idle' | 'sending' | 'sent' | 'error'>('idle');

  async function onSubmit(e: FormEvent<HTMLFormElement>) {
    e.preventDefault();
    setStatus('sending');

    const data = new FormData(e.currentTarget);
    data.set('access_key', 'YOUR_ACCESS_KEY');
    data.set('subject', 'New vet appointment request');

    const res = await fetch('https://splitforms.com/api/submit', {
      method: 'POST',
      body: data,
      headers: { Accept: 'application/json' },
    });

    const json = await res.json();
    setStatus(json.success ? 'sent' : 'error');
    if (json.success) e.currentTarget.reset();
  }

  if (status === 'sent') return <p>Thanks — we&rsquo;ll be in touch.</p>;

  return (
    <>
    <form onSubmit={onSubmit}>
      <label htmlFor="owner_name">Owner name *</label>
      <input id="owner_name" type="text" name="owner_name" placeholder="Sofia Reis" required />
      <label htmlFor="email">Email *</label>
      <input id="email" type="email" name="email" placeholder="sofia@example.com" required />
      <label htmlFor="phone">Phone *</label>
      <input id="phone" type="tel" name="phone" placeholder="+1 555 0142" required />
      <label htmlFor="pet_name">Pet name *</label>
      <input id="pet_name" type="text" name="pet_name" placeholder="Biscuit" required />
      <label htmlFor="species">Species *</label>
      <select id="species" name="species" required>
        <option value="">Choose…</option>
        <option>Dog</option>
        <option>Cat</option>
        <option>Rabbit</option>
        <option>Bird</option>
        <option>Reptile</option>
        <option>Other</option>
      </select>
      <label htmlFor="breed">Breed</label>
      <input id="breed" type="text" name="breed" placeholder="Tabby" />
      <label htmlFor="age">Age</label>
      <input id="age" type="text" name="age" placeholder="3 years" />
      <label htmlFor="reason">Reason for visit *</label>
      <select id="reason" name="reason" required>
        <option value="">Choose…</option>
        <option>Annual checkup</option>
        <option>Vaccinations</option>
        <option>Sick visit</option>
        <option>Dental</option>
        <option>Surgery consultation</option>
        <option>Spay / neuter</option>
        <option>Emergency</option>
        <option>Other</option>
      </select>
      <label htmlFor="preferred_date">Preferred date *</label>
      <input id="preferred_date" type="date" name="preferred_date" required />
      <label htmlFor="symptoms">Symptoms / details</label>
      <textarea id="symptoms" name="symptoms" placeholder="When it started, eating habits, behavior changes…" />

      <button type="submit" disabled={status === 'sending'}>
        {status === 'sending' ? 'Sending…' : 'Send'}
      </button>

      {status === 'error' && <p>Something went wrong. Try again.</p>}
    </form>

      <p style={{ marginTop: 12, fontSize: 11, color: '#888', textAlign: 'right' }}>
        Powered by <a href="https://splitforms.com" target="_blank" rel="noopener" style={{ color: '#888', textDecoration: 'none' }}>splitforms</a>
      </p>
    </>
  );
}

04PHPsubmit.php28 lines

<?php
// Drop into a PHP page. Receives a form POST and proxies it to splitforms.com.
// Useful when you want to add server-side validation or rate limiting.

if ($_SERVER['REQUEST_METHOD'] === 'POST') {
    $allowed = ['owner_name', 'email', 'phone', 'pet_name', 'species', 'breed', 'age', 'reason', 'preferred_date', 'symptoms'];
    $payload = ['access_key' => 'YOUR_ACCESS_KEY'];
    $payload['subject'] = 'New vet appointment request';

    foreach ($allowed as $f) {
        if (isset($_POST[$f])) $payload[$f] = $_POST[$f];
    }

    $ch = curl_init('https://splitforms.com/api/submit');
    curl_setopt($ch, CURLOPT_POST, true);
    curl_setopt($ch, CURLOPT_POSTFIELDS, http_build_query($payload));
    curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
    curl_setopt($ch, CURLOPT_HTTPHEADER, ['Accept: application/json']);
    $response = curl_exec($ch);
    $status   = curl_getinfo($ch, CURLINFO_HTTP_CODE);
    curl_close($ch);

    header('Content-Type: application/json');
    http_response_code($status);
    echo $response;
    exit;
}
?>

05cURLtest.sh14 lines

curl -X POST https://splitforms.com/api/submit \
  -H "Accept: application/json" \
  -d "access_key=YOUR_ACCESS_KEY" \
  -d "subject=New vet appointment request" \
  -d "owner_name=Jane Builder" \
  -d "email=jane@example.com" \
  -d "phone=+15555555555" \
  -d "pet_name=Jane Builder" \
  -d "species=Dog" \
  -d "breed=Jane Builder" \
  -d "age=Jane Builder" \
  -d "reason=Annual checkup" \
  -d "preferred_date=2026-05-15" \
  -d "symptoms=Hello from cURL"

Replace YOUR_ACCESS_KEY with the key from your dashboard. That’s the only edit.

§ 04bUse this template with…17 frameworks · same backend

One template. Every framework.

The same field set works on every framework splitforms supports. HTML, React, Next.js, Vue, Astro, Hugo, WordPress — same POST, same backend.

§ 06FAQ4 answered

Things people ask before they ship.

Direct answers, no marketing fluff. Missing one? Email hello@splitforms.com.

01Can I integrate with Cornerstone / AVImark / ezyVet?

Yes — webhook the JSON to your practice management software via Zapier. Lead lands with pet name, species, owner contact, and reason for visit ready for the appointment book.

02How do urgent / emergency cases get triaged?

Form's symptom dropdown auto-flags urgent cases (collapse, breathing trouble, hit-by-car). Webhook fires an SMS to the on-call vet immediately. Less urgent cases (mild diarrhoea, eye discharge) fit the same-day or next-day slots.

03What about new-pet onboarding?

New pets need vaccine records and prior-vet info. Auto-respond to first-time submissions with a checklist. The pet record gets created in your software ahead of arrival.

04Does this work for exotics?

Yes — the species field is open enough to handle reptiles, birds, rabbits, ferrets. Practices that don't see exotics route those leads to a referring exotics practice via webhook. Common in metro areas.

✻ ✻ ✻

Ship your veterinarian appointment request form in 60 seconds.

1,000 free submissions per month. No credit card. Copy the snippet, paste your access key, watch leads land in your inbox.

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v0.1 · founders pricing locked in · early access open