New Client Info

New Client Information Form

Please fill out the following information and ensure that your pet's full medical records, including vaccine history and doctor's notes, are sent to us before your appointment to ensure that the medical team can thoroughly review your medical history before your visit.

Please note that a deposit per pet will be required at the time your appointment is scheduled and this will be applied to your first visit. Keep in mind that vaccines/other services will be an additional cost.

Please note if there is a no-call/no-show or a reschedule within 24 hours, your deposit will be retained. You may request a refund for the deposit if canceling greater than 24 hours in advance.

Client Information

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip Code: *

Email: *

Phone: *

Secondary name/owner (if applicable):

Secondary phone number (if applicable):

Pet's name: *

Age or DOB: *

Dog/Cat *

Dog

Cat

Male/Female *

Male

Female

Spayed/Neutered? *

Yes

Unknown

Breed: *

Color/Markings: *

Upload Pet Records

Maximum file size: 52.43MB

Requested day of appointment:

Time of appointment:

Reason for visit:

Establish care (wellness visit and/or vaccines)

My pet is sick, please describe

Spay/Neuter

Other (please describe)Other (please describe)

Do you have any medical concerns?

Have you attached ALL prior medical records?

Yes

Please note that a deposit per pet (amount dependent on appointment needed) will be required at the time your appointment is scheduled and this will be applied to your first visit. Keep in mind that vaccines/other services will be an additional cost. *Deposits for first appointments are due at the time of scheduling, if you are unable to pay the deposit upfront the appointment will not be scheduled until payment is received.

I have read and agree to the statement above.

Signature:

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ScribbleVet Consent and Release

Our veterinary services utilize ScribbleVet, a tool from Kairo Care, Inc., which records your pet's appointments for improved clinical documentation. We need your consent to proceed with the recording. By signing this agreement:

Appointment Recording: You agree that your vet appointments may be recorded. If you don’t want to be recorded, let us know.
Usage Rights: You grant us permission to share these recordings, and any other materials you choose to provide, for the purpose of improved clinical documentation.
Age Confirmation & Understanding: You affirm that you are at least eighteen years old, and that you understand and accept the terms in this agreement

We are committed to providing the best care for your pet in a manner comfortable for both of you.

ScribbleVet Agreement - Client Information

Name

First Name

Last Name

Email *

Signature

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New Client Information Form

Client Information

ScribbleVet Consent and Release

ScribbleVet Agreement - Client Information

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