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Mulberry Grove Animal Hospital - New Patient Form
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    We encourage you to establish a Pet Portal via PetPro Connect which will allow you to check on your pet’s vaccines records, request prescription refills, receive email reminders, and access many articles about pet health. Please provide your email address so that we may send you an invitation to establish your PetPro portal.

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    I grant to Mulberry Grove Animal Hospital, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that Mulberry Grove Animal Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising and Web content.
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    Photo Permission Release
    I grant to Mulberry Grove Animal Hospital, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that Mulberry Grove Animal Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising and Web content.
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    Patient's Information

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    • Male
    • Female
    • Male Neutered
    • Female Spayed
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    • Male
    • Female
    • Male Neutered
    • Female Spayed
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    Medical History

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    If this is your pet's first visit we would appreciate the records to be sent to us at least 7 days before your appointment, if possible. This will help our doctors and staff become familiar with your pet's history prior to their appointment.
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    I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet/pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED
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    Authorization
    I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet/pet(s).
    I assume responsibility for all charges incurred in the care of this animal.
    I also understand that ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.

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  • 25

    NO SHOW & LATE POLICY

    A veterinary/client relationship is built on mutual trust and respect. As such, we strive to be on time for your scheduled appointments and ask that you give us a call when you are unable to keep your appointment. We understand that sometimes you may need to cancel or reschedule your appointment. However, when you do not call in advance to cancel your appointment you may be preventing another pet from getting much-needed treatment. As a courtesy, we provide reminder texts before your appointment.

    Our missed and late arrival policies are outlined below.

    Late Arrival Policy: We make every effort to be on time for all our appointments. Unfortunately, when even one patient arrives late, it can disrupt the entire schedule for that day. In addition, rushing or "squeezing in" an appointment shortchanges the patients and contributes to decreased quality of care.

    To minimize the impact of late arrivals, a grace period of 10 minutes will be allowed for unforeseen delays you may encounter while traveling to our hospital. If you arrive more than 10 minutes late for an appointment, we may offer options of being seen as a work-in (additional fees apply), day admission, or rescheduled.

    Cancellation of an Appointment: Appointments are in high demand, and your early cancellation will allow another patient access to timely veterinary care. To be respectful of the medical needs of other patients, please call our office promptly if you are unable to show up for an appointment. If it is necessary to cancel your scheduled appointment, we ask that you call at least 24 hours in advance. If it is after hours, please leave this message on our voicemail.

    No Show Policy: A "no show" is a client who misses an appointment or surgery without canceling it. A failure to be present at the time of a scheduled appointment will be recorded in the patient's chart as a "no show".

    The first time there is a "no show", we will attempt to contact you via phone/text/email to inform you of the missed appointment and remind you of our "no show" policy. Apart from a one-time forgiveness, you will be required to pay a nonrefundable $25 no-show fee at the next scheduled appointment. Clients who have two or more "no shows" for appointments cannot schedule future appointments without pre-paying for a physical exam. If a client does not show up to the scheduled appointment the prepaid exam is non-refundable.

    We appreciate your patience, understanding and support regarding these policies.
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