Appointment Check In

Appointment Check In
Please fill out the form below to speed the check in process for your pet's appointment.
Pet Parent Name*

First Name Last Name
Pet Name:*
Preferred Phone Number*

Area Code Phone Number
General Health
Does your pet have any allergies? If so, please list below.
What food does your pet eat?
Does your pet have any dietary restrictions?
Since your pet's last appointment has he or she been eating, drinking, urinating and defecating normally? If not, please list incidents below.
Medications and Supplements

Please list all of the behavior medications that your pet is currently taking including the strength and dosing frequency.

Type a question

	Name	Formulation	How many?	How many times per day?
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5

Write any and all medications and supplements that your pet is currently taking that are not listed above.
Does your pet need a refill on their medication? If so, please list the needed medication below.
Cancellation policy
We strive to provide excellent behavioral medical care to all of our patients. New patients often wait 3-4 months to see one of our doctors. When appointments are cancelled without adequate notice, it prevents other patients from receiving care. For that reason, please give us one business day's notice when cancelling or rescheduling an appointment. Contact our CCRs at 561-795-9398 by phone or text to reschedule your pet's appointment. The policy applies to all doctor, technician and nurse appointments whether in person or by telemedicine. Please check the boxes below to acknowledge that you have read and accept the FVBS cancellation policy.
If you are 10 minutes or more late for your appointment, it will be automatically rescheduled.*
$150 prepayment will be forfeited if assessment appointments are cancelled or rescheduled with less than two business day's notice.*
$45 fee applied to your account if appointments are cancelled or rescheduled with less than one business day's notice.*
$65 fee applied to your account if no notice (no show) for a missed appointment.*
A second no notice (no show), you will be required to submit full payment when the appointment is scheduled. This fee is non-refundable..*
Telehealth appointments may be recorded for internal training only.
Should be Empty:

Appointment Check In

General Health

Medications and Supplements

Cancellation policy