Client Information

This information will only be use for the purpose of records and will remain private.

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone / Cellphone

(###)

###

####

How did you hear about us?

Pet Information

Pet's Name

Date of Birth

YYYY

Breed

Color

Weight (Approximately)

Pet's Sex

Male

Female

Spay / Neuter

Yes

Microchipped

Yes

Reason for Visit?

Please let us know the reason for your veterinary request and any questions or concerns.

Medical Information / History

Please share your pet's prior veterinarian information so we can obtain previews vaccination records.

Has your pet ever had an allergic reaction to vaccines or medication?

Yes

Has your pet previously been diagnosed with any medical issues / allergies?

Yes

Behavior Notes / Special Considerations

To ensure the best and safest experience for both you and your pet, please let us know if your pet has any behavioral concerns, such as anxiety or fear aggression.

Calming Medications

Have you ever given your pet medication to help with appointments or stressful situations?

Yes

Handling Tolerance

Are you able to safely hold or restrain your pet for about 2 minutes if they become agitated?

Yes

Aggressive Signals

Has your pet ever growled, hissed, curled lips, lunged, or shown similar behaviors toward anyone?

Yes

Muzzle Use

Has your pet ever worn a muzzle or been asked to wear one in the past?

Yes

Biting History

Has your pet ever bitten anyone?

Yes

Is there anything else you’d like us to know about your pet.

Helping Us Approach Your Pet

We want each visit to be as stress-free as possible for you and your pet. Please let us know what your pet enjoys (like favorite treats) and what makes them uncomfortable (such as paw handling or loud noises) so we can tailor our approach. Because vet visits involve things pets don’t experience every day—like restraint, touching sensitive areas, or procedures such as vaccinations—practicing at home can really help. Try gently handling their ears, paws, or mouth, or practicing calm restraint for short periods with treats and praise. If your pet becomes too anxious for us to safely continue, we may use tools like a muzzle or discuss rescheduling with anti-anxiety medication. Please note the house call fee still applies even if a full exam cannot be completed, but we will always do our best to keep the visit safe, compassionate, and positive. Our goal is to reduce fear over time so your pet can learn that vet visits aren’t so scary—and maybe even a little enjoyable!

Services We Do Not Provide

Please note that we are unable to offer emergency care, hospitalization, full anesthesia/sedation, dental cleanings, X-rays, or surgical procedures. If your pet requires these services, we will happy to refer you to a trusted local veterinary partner.

Payment Policy

We accept credit cards (Visa, MasterCard, Discover, American Express), cash, debit cards, Zelle, and Venmo. All payments are due in full at the time of service.

Cancellation Policy

If you need to cancel your appointment, please provide at least 48 business hours’ notice. Cancellations made after this time will result in your reservation deposit being non-refundable.

By checking this box, I confirm that I understand and agree to the above requirements.

New Client / Patient Form