Initial Consult Form

Initial Consultation Form

(Form required for each pet)
Pet's Name: *
Species: *

Canine Feline
Where does your pet spend the majority of its time? *
What type(s) of diet is your pet currently on? (Check all that apply) *

Kibble Canned Raw (Store-bought) Dehydrated Raw (Store-bought) DIY Raw DIY Homemade
Please list the brand(s) or diet ingredients (if DIY): *
Has your pet ever had a reaction to any food proteins that you are aware of? *

No Known Allergies Chicken Turkey Beef Fish Pork Lamb Duck Venison Rabbit Other
Please list any additional treats given: (type N/A if none) *
Is your pet current on vaccinations? *

Yes No - never vaccinated No - but has had vaccines prior
Which vaccines has your pet had? (please check all that apply) *

Rabies (dog/cat) DHPP (dog) Bordetella (dog) Influenza (dog) Leptospirosis (dog) Lymes (dog) FVRCP (cat) Leukemia (cat) FiV (cats) FIP (cats)
Is your pet current on heartworm prevention? *

Yes No
If YES, what prevention brand do you use. If NO, when was last dose? *
Is your pet current on flea and/or tick prevention? *

Yes No
If YES, what prevention brand do you use. If NO, when was last dose? *
Is your pet on any prescription medications? *

Yes No
Please list ALL prescription medicines your pet is on: (type N/A if none) *
Is your pet on any OTC medications/supplements? *

Yes No
Please list ALL supplements your pet is on: (type N/A if none) *
Please check all applicable (current and prior) health issues: *

Skin issues Ear infections Eye infections Itchy Skin Allergic Reaction(s) Vaccine Reaction(s) Heartworm Disease Seizures Allergies Thyroid Disease Cancer Kidney Disease Liver Disease Growths/Masses/Lumps Coughing/Sneezing Dental Disease N/A
Please tell us why you would like us to see your pet, what issues specifically you would like addressed/treated, and any goals you wish to reach with your pet's health. *
Please read and sign/agree in order to schedule appointment:

1. I understand that IVS requires ALL prior health records (as far back as possible, with lab results included) be submitted before we can schedule appointment.

2. I understand that a deposit of $75.00 (half of the initial consult fee) will be required to schedule, and the deposit will only be refunded if a minimum of 72 hours notice is given to cancel and/or re-schedule set appointment.

3. I understand that IVS is a part-time, appointment-only practice. I also understand because of this, that IVS will respond to email (e-mailing staff@integrativepets.com is the fastest way for a response) and/or phone inquires as soon as possible, but that it is possible that it sometimes may take 24-72 hours for a response.

4. I understand that that IVS is not a full service practice and is not capable of seeing urgent, emergent, or surgical cases.

5. I understand that there may be times IVS will have to refer my pet to our regular full-service veterinarian due to scheduling, equipment, and/or availability constraints.
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Initial Consultation Form