New Client Form

311 West Gray St, Suite A Houston, TX 77019 Phone: 832-701-0077 info@furandfeathervet.com www.furandfeathervet.com
New Client Form

Thank you for the opportunity to care for your beloved pet. Our goal is to treat your pet with the same love and quality care that we would with our own, and to provide the highest quality service. We take an integrative approach for the best health care with strong emphasis on nutrition as a base for excellent health. Please help us meet your needs and the needs of your pet by sharing the following important information:
Pet Owner's Name: First Name * Last Name *

Address: Street Address
City   State   Zip

Home Phone:    Phone Number Cell Phone: Phone Number

Email Address:   Email *
Employer: Name

Work Phone: Phone Number
New Client Appointment Availability

Mornings Afternoons Evenings Soonest Available Other
*** Please understand that your appointment can not be scheduled until we have all available veterinary records on hand (can send to Info@FurAndFeatherVet.com).

Having these documents will help Dr. Luper and the technicians familiarize themselves with your pets veterinary history.
Significant Other/Co Owner: Name

Cell Phone: Phone Number

Email Address: Email
Emergency Contact:
First Name Last Name

Cell Phone: Phone Number
How did you hear about us?: *
Or referred by (We would like to thank them):
May we take photographs of your pet(s) for educational purposes or for our social media? We will not release personal information such as your name.:

Yes No
PET INFORMATION
Pet's Name:
Date of Birth/Approximate Age:
Species: *
Breed:
Color/Markings:
Sex:

Female Spayed Female Male Neutered Male
Where and when did pet come to be in your family?:
Are there other pets in your household?:

Yes No
If Yes, please indicate quantity:

Dogs: # Cats: #

Birds: # Reptiles: #
Other (Please specify):
Are they doing well?:
Are they up to date in preventative care?:
Would you like to add your other pets to our files?:
Reason for visit?:
We are Fear Free Certified and want to make this visit as easy as possible for all pets.
Is your pet fearful, anxious, or aggressive during veterinary visits?:

Yes No
Would you be interested in doing an initial Fear Free Examination (which is complimentary) for your pet's first visit instead?:

Yes No
This allows your pet to have a happy first impression without any procedures it may be anxious about. It also allows our doctor to determine if herbal or medicinal help is warranted to give your pet prior to next the wellness visit in which procedures will be done.

Please call us 48 hours prior to your scheduled appointment if you would like to switch to a Fear Free Exam, or if you would like more details.
How is your pet doing?
Energy level:

Normal Increased Decreased
Current appetite:

Normal Increased Decreased
Drinking:

Normal Increased Decreased
Urination:

Normal Increased Decreased
Bowel Movements:

Normal Increased Decreased
Other:
Have you noticed any;

Vomiting Coughing Limping Sneezing Seizures Discharge from Eyes Discharge from Nose None
Please describe:
Skin Problems?

Sores/Scabs Redness Scaly Flaky Odor Itching Chewing Hair Loss Lumps/Bumps
Location:
Ear Problems?

Itching Redness Discharge Head Tilt Pawing/Shaking Odor None
Any Behavior Issues?

House Soiling Inappropriate Chewing Excessive Barking Destructive Aggression Fearful at Home Other
Tell us about your pet's activities
How much time does your pet spend outdoors?

0% 25% 50% 75% 100%
If pet goes outside, where does it go?

Backyard Around Neighborhood Parks/Lakes/Ponds Spend Time in Country Other
What plant(s) does your pet have access to? This is important to know because some can be toxic to your pet.:
(Sago Palms, Palm trees, Lilies, Oleander, etc.)
Does your pet get professionally groomed?

Yes No
Does your pet board in a kennel facility?

Yes No
Nutrition
What kind of food do you feed your pet?
Please specify brand/types and how often of each:

DRY BRAND
Brand/Type:    How often/much:   cups / ounces

CANNED BRAND
Brand/Type:    How often/much:  can size / portion

RAW BRAND
Brand/Type:    How often/much: ounces / pounds

TREATS
Brand/Type:    How often/much: amount per day
People food? How often? (Please specify):
Animal Bones? How often? (Please specify type such as raw meaty bones):
Current or Previous Medical Conditions
Does your pet have any allergies/sensitivities to food, medication, vaccines, etc? If yes, please describe reaction:
Has your pet had any surgeries or anesthesia procedures?:
Did your pet have any problems/complications with anesthesia?
Medications
List all medications, supplements, and herbals your pet is currently receiving:

Brand/Type: name   Dosage:

Brand/Type: name   Dosage:   frequency

Brand/Type: name   Dosage:   frequency

Brand/Type: name   Dosage:   frequency
Vaccination and Medical History
Name of Hospital/Clinic where records can be obtained?:

Hospital/Clinic: name * Phone: Phone Number*

Email: Email

*Many hospitals/clinics require owner release of their pet's records
Heartworm Preventative
Is your pet currently taking heartworm preventative?

Yes No
Name of Heartworm Preventative: name
Most Recent Date Given:

Month Day Year
Date
If No, when was last dose given?:
Flea/Tick Control Products
Have you seen any Fleas or Ticks?:

Yes No
Flea/Tick products used?:
Flea/Tick Products used?

Pet: brand

House: brand

Yard: brand
Have you seen feral cats in your community?:

Yes No
Is your pet active in woody areas, tall grassy areas or leafy ground cover (including bayou and other trails in the area, or parks/campgrounds/etc)?:
Have you seen ticks or removed ticks from your pets or a family member recently?:

Yes No
Has your pet routinely tested for tick borne diseases or been found to be positive?:

Yes No
Dental Care
Do you brush your pet's teeth?:

Yes No
Other dental care methods:
Date of last dental cleaning:

Month Day Year
Date
Identification
Does your pet have Microchip Identification?

Yes No
We believe in all pets being microchipped. Would you like more information on this?:

Yes No
Pet Insurance
Is your pet covered under any pet insurance?:

Yes No
Would you like information on Veterinary Pet Insurance?:

Yes No
Is there anything else you would like to mention or have concerns about?:
We gladly provide a written Health Care Plan with associated professional fees. This will be important to you since ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. In cases of extensive medical or surgical procedures, when full payment may be difficult at discharge, we accept Visa, Mastercard, American Express, Discover, or Care Credit.
Dear Fur & Feather Veterinary Hospital Clients:

We are asking that our clients please call in advance if unable to keep a previously scheduled appointment, including boarding reservations, grooming and drop-off appointments. Clients who need to schedule an appointment for their pets, especially a sick pet, appreciate the opportunity to utilize the available appointment time and obtain the care that their pet needs.

This letter notifies our clients that a $65.00 Missed Appointment Fee will be billed to the account if a courtesy cancellation call is not received 24 hours prior to the booked appointment time.

We thank you for trusting our team to provide the very best care for your beloved pets. We value you and our patients. If you have any questions, please feel free to ask to see me or just give me a call.

Sincerely,

Hospital Administrator

I have received a copy of this notice and I understand the above policy.
Client Name: First Name* Last Name*
Signature *

Clear
Date:

Month Day Year
Date
Should be Empty:

PET INFORMATION

Tell us about your pet's activities

Nutrition

Current or Previous Medical Conditions

Medications

Vaccination and Medical History

Heartworm Preventative

Flea/Tick Control Products

Dental Care

Identification

Pet Insurance