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Client Information

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*** At this time we are only seeing curbside and drop off appointments ***
We are offering curbside appointments with the options of: Phone Call (speakerphone during the exam)
Video Chat via the website doxy.me (link will be provided)
Drop off appointments will be contacted via phone after the exam

If you are a new client, welcome! We look forward to meeting you! Please fill out the form below so that we can update your account in our computer system.
If you are a current client and your information has changed, you can also
submit this form so that we can make sure we have your best contact information.
Thank you for your cooperation in letting us assist you.

Primary Owner's First Name*

Primary Owner's Last Name*

Salutation*

Ms.

Mrs.

Mr.

Dr.

Address*

Street Address

City

State

ZIP

Phone*

Email*

May we send you text messages?*

Yes

No

What is your preferred method of contact?*

Phone

Text

Email

Occupation*

Company*

Please tell us how you heard of us?*

Secondary Owner's First Name*

Secondary Owner's Last Name*

Salutation*

Ms.

Mrs.

Mr.

Dr.

Phone*

Email*

What is their relationship to you?

Patient Information

Cat's Name*

Date of birth (or approximate age):*

Breed*

Spayed/Neutered*

Spayed

Neutered

N/A

What is the sex of your cat?*

Male

Female

Are your cat's vaccines current?*

Yes

No

Do you have your cat's medical records?*

Yes

No

May we request your cats medical records from another veterinary practice?*

Yes

No

May we use any images of your pets we obtain on our social media sites, anonymously?*

Yes

No

May our employees share pictures of your cat taken in the clinic on their personal website and social media sites?*

Yes

No

Name of former veterinary practice

Please list any additional pets you may have:

*IMPORTANT*
If you have not already scheduled an appointment, please call the clinic and fill out and submit the Appointment Patient History Form.

COVID-19 Procedures

Due to the COVID-19 prevalence, we want to ensure your safety and that of our team. Please answer yes/no to these questions:

*Please note: Answering yes does NOT prohibit your pet from being seen if they are ill but allows us to put appropriate safety parameters in place for our team and doctors.

Do you, or someone in your household, have symptoms consistent with COVID-19, a fever, cough or difficulty breathing?

Yes

No

Have you, or someone in your household, been exposed to someone who has tested positive for COVID-19?

Yes

No

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Name

This field is for validation purposes and should be left unchanged.