What is your pet name? {!! Form::text('pet_name' , null , ['class' => "form-control",'placeholder' => 'Pet Name','required'=>'true']) !!}

Estimated birthdate of your dog? (If you don't know your pets special date, we'd love to make today their birthday.) *

What is the species of your pet?* {!! Form::select('species' , ['dog' => 'Dog'] , null , ['class' => 'form-control pet_type']) !!}

What is the breed of your pet? *(If you have a mixed breed, select the dominant breed) {!! Form::select('pet_type' , $petBreed , null , ['class' => 'form-control pet_type' ,'required'=>'true']) !!}

What is the estimated weight of your pet? {!! Form::text('pet_weight' , null , ['class' => 'form-control','placeholder' => 'Pet Weight','required'=>'true']) !!}

How would you describe your pets weight? *

What is the sex of your pet? *

How old is your pet? *

Is your pet pregnant? *

Is your pet on any medication? If yes, what type of medication and for what issue? Please select all that apply from the choices below. *