New Patient Form | Dr Abby’s Vet Clinic Copy

New Patient Form

Please note that if your pet is not Rabies vaccinated and is over the age of 16 weeks, they will be given a Rabies vaccine at the time of exam. This is a STATE LAW. INITIAL BELOW

First name

Last name

Phone

Email

Co Owner First Name

Co Owner Last Name

Phone Number

Address

Pet Name

Age

Species

Breed

Color

Male or Female

Male

Male Neutered

Female

Female Spayed

Mircochipped

Yes

No

Currently on Flea and Tick Prevention

Yes

No

Flea and Tick Prevention Brand

Provide a brief summary of your pet's medical history.

List ALL medications currently be used or have been used in the last 12 months.

Please describe your pet's temperament at the vet. Also please note how your pet does with other people/animals.

REQUIRED PLEASE READ AND SIGN- Your signature below indicates you have read and understand the following information.

Dr. Abby and her team work hard to provide routine healthcare and timely medical services to our clients and their pets. Late arrivals and no show/no call appointments make it difficult to maintain a daily schedule that serves all the clients and pets who need services that day. Please give us 24 hours notice to cancel your appointment. Understanding and respecting these policies listed below is greatly appreciated.

Signature

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A one time $70.00 deposit is required to schedule your pets initial exam. If there is a no show or late cancel, the deposit will not be refunded. INITIAL BELOW

Dr. Abby uses a program that records the audio of the appointment to make note taking more efficient. Please approve or decline being recorded.

Approve

Decline

Appointment cancellation/rescheduling requires at least 24 hours notice. Failure to provide ample notice will result in additional fees. INITIAL BELOW

Late arrivals to scheduled appointment (10 mins or more) will result in additional fees or reschedule with a deposit. INITIAL BELOW

Prescription refills require 48-72 hours notice. Our team will notify you when its ready for pick up. Failure to provide ample notice will result in additional fees. INITIAL BELOW

Payment is required in full at the time of service. Please note there is a 3% fee on all credit/debit card transactions. INITIAL BELOW

For everyone's safety, All dogs MUST be on a leash, All cats MUST be in a carrier upon arrival. If you do not have a carrier, one will be provided at an additional cost. INITIAL BELOW

PLEASE UPLOAD YOUR PETS RECORDS, IF YOU DO NOT HAVE A COPY OF YOUR PETS RECORDS PLEASE CALL YOUR PREVIOUS CLINIC AND HAVE THE RECORDS EMAILED TO US AT ABBYVETCLINIC22@GMAIL.COM- AFTER WE RECEIVE YOUR RECORDS AND INFORMATION WE WILL CALL YOU TO SCHEDULE

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