New Client Form for Small Mammal

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:      Work Phone: Phone Number

Significant Other or Co Owner:

Name:First Name    Last Name

Cell Phone: Phone Number

Email Address:   Email

Emergency Contact:

Name: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 :

YesNo

Pet's Name:

Date of Birth/Approximate Age:

Species:*

Breed:

Color/Markings:

Sex:

FemaleSpayed FemaleMaleNeutered Male

Where and when did pet come to be in your family?:

Are there other pets in your household?:

YesNo

If Yes, please indicate quantity:

Dogs: # Cats: #

Birds: # Reptiles: #

Other (Please specify):

Origin Source (Breeder, Pet Shop, etc):

What type of cage / enclosure does your pet have and approximate size?:

Where in the house is the enclosure located?:

Does your pet spend time outside the enclosure?:

YesNo

If Yes, How much? / Where?:

Are other pets sharing the enclosure, or in direct contact?:

How often is the enclosure cleaned, and what products are used?:

What kind of food do you feed your pet?
Please specify types/brands and how often of each:

Brand/Protein: name   How often/much: frequency

Brand/Protein: name   How often/much: frequency

Brand/Protein: name   How often/much: frequency

Dry Food / Pellets?:
Brand: name How often/much: amount

Hay? (if applicable) :

Vegetables / Fruits?:

Treats?:

Other?:

Ex: protein

Do you give your pet suppliments?
Please specify types/brands and how often of each:

Brand/Type: name   How often/much: frequency

Brand/Type: name   How often/much: frequency

Brand/Type: name   How often/much: frequency

Please list any previous medical problems:

Does your pet have any behavior problems?:

Have you noticed any of the following?
If so, please describe:

Decreased appetite / Increased appetite:

Weight gain / Weight loss:

Vomiting / Diarrhea:

Difficulty breathing:

Lethargy:

Nasal or Eye Discharge:

Have there been any changes in your pet's stool droppings? Please Describe:

(number, color, consistency).

FERRETS ONLY: Has your ferret ever been vaccinated for rabies or ferret distemper?:

YesNo

FERRETS ONLY: If so, have they ever had a vaccine reaction?

Name of Hospital/Clinic where records can be obtained?:

Hospital/Clinic: name * Phone: #*

Email: email

*Many hospitals/clinics require owner release of their pet's records

Does your pet have Microchip Identification?:

YesNo

We believe in all pets being microchipped. Would you like more information on this?:

Is your pet covered under any pet insurance?:

YesNo

Would you like information on Veterinary Pet Insurance?:

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.

Thank You for being a valued client with Fur & Feather!

We are updating our Cancellation Policy

as follows:

As of May 1, 2024, all appointments with the Doctor will require a Scheduling Fee.

Scheduling Fees are non-refundable for cancellations made within 24hrs of the scheduled appointment time.

Cancellations made prior to the 24hr window may have a partial refund returned to the card used to make the payment (minus $14 Processing Fee).

***The full Scheduling Fee amount may be utilized as a Credit on Account for future services.

We appreciate your understanding as we strive to provide excellent service to our patients in need!

Optional

I authorize a Card to be held on file for future transactions.

Client Name: First Name * Last Name *

Client Signature:*

Date:

Date

PET INFORMATION

Identification

Pet Insurance