Initial Consult Form

Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Spouse/Co-Owner
Spouse/Co-Owners's Phone Number
Spouse/Co-Owner's Email
example@example.com
How do you prefer to receive appointment confirmations?*

TextEmailPhone Call
Pet's Name*
Breed*
Birthday or Age*
Please select one*

Male NeuteredMale IntactFemale SpayedFemale Intact
How did you hear about us?*

Veterinary Referral- my primary vet/clinicVeterinary Referral- specialist (surgeon, neurologist, etc)Online- website/social media/etcA current FVR clientAnother animal professional (trainer, groomer, rescue, etc)Friend/Word of MouthOther
If an FVR client referred you, let us know who it was:
Primary Care Veterinarian (Records will be sent after initial visit)*
What other veterinary hospitals has your pet been to in the last 12 months? (please note the reason, approximate dates of care, and the hospitals):*
Has your pet had any diagnostics done in the last 12 months? Diagnostics include ultrasounds, radiographs, bloodwork, etc. Please include the name of the hospital where the diagnostics were performed.*
Does your pet have, or have they been treated for, any other medical conditions?*
What problem brings you to Florida Veterinary Rehabilitation, please be specific (when did it start, when was it first noticed)?*
What are your goals for your pet's rehabilitation?*
What changes have you noticed in your pet's regular activity level?*
What is your pet's current daily activity including frequency and length of walks, etc?*
Does your pet currently require assistance for normal activities such as walking, getting up, getting into or out of the car, positioning for urination/defecation, etc? Please explain*
What type of flooring do you have in your home? Is your pet slipping or having trouble getting up on slick surfaces such as hardwood/tile?*
Are there any other pets at home? *
Does your pet have any behavioral issues that we should be aware of? For example, are they fearful or do they have any reactivity towards dogs or humans?*
What medications does your pet receive? Include name, dose and frequency. *
What supplements/vitamins does your pet receive? This may include fish oil, glucosamine, or other supplements. Please include name, dose and frequency.*
What does your pet eat? Please indicate brand, form (kibble/canned/freezedried), primary protein (beef, chicken, etc) and amount fed. Also include all treats.*
Does your pet have any food allergies? *
When your pet comes to FVR for therapy, which high-value treats are okay for them to eat? If your pet has allergies or specific dietary restrictions please explain in the "Other" box*

Cloud Star Tricky Trainers Chewy CheddarCloud Star Tricky Trainers Chewy SalmonCloud Star Tricky Trainers Crunchy CheddarCloud Star Tricky Trainers Crunchy SalmonPeanut ButterWag More Bark Less Itty Bitty Smooth Aged CheddarWag More Bark Less Itty Bitty PumpkinWag More Bark Less Itty Bitty Peanut Butter & ApplesNatural Cravings Beef Sizzle SticksAny treats are fineNone of the above, I will bring my own treatsOther
Does you pet participate in any sports, competitions, or is working dog?
Does your pet have insurance? If so, what company? Many pet insurance policies cover rehabilitation. Please contact your insurance carrier directly for details about your pet's policy.
FVR Policies
We thank you for selecting us to serve your needs. Our entire staff is a team dedicated to providing the highest quality care and service to our clients and patients. We take great pride in each staff member’s training and capabilities.

We ask that you take a few minutes and read over our practice policies. If you have any questions, please do not hesitate to direct your questions to our Practice Manager who will be most happy to address your concerns.

Thank you, and once again, welcome!

APPOINTMENTS

We strive to keep the waiting time of our clients to a minimum. We recognize that your time is valuable; therefore, we are able to see our clients and patients on an appointment basis. We consider an appointment made to be an agreement and commitment between our office and our clients.

Late Arrivals- See additional policy below

Appointments involving clients arriving more than fifteen (15) minutes late will be considered late appointments and will be subject to the missed appointment fees. If you think you are going to be late, we ask that you call us as soon as possible to determine if your late arrival can be accommodated or if you will need to reschedule.

EMERGENCIES

As emergencies do arise, we ask for your patience and understanding. Occasionally, we must see an emergency patient before you or during your appointment. We will try to inform you of any changes necessary ahead of time, if at all possible.

If you have an emergency, please call the office right away. We will do everything possible to get your pet in at the earliest opportunity. If we are out of the office or if it is after office hours, please leave a detailed message.

Send an email to info@flvetrehab.com for after hours email correspondence.

FINANCIAL ARRANGEMENTS

Our policy is full payment due when services rendered. We accept cash, checks, all major credit cards, and Care Credit. Care Credit is great to have for emergencies with no interest fees. We will be happy to assist you with the application and it will take less than five minutes.

PACKAGES

Prepaid packages for therapeutic exercise are to be used within 6 months, if not used they will be voided with no return credit onto the account. If there is a scenario that renders the package not usable please contact the Practice Manager at carrie @flvetrehab.com before the 6 month period.

OUR COMMITMENT TO YOU

We appreciate having you as a client in our practice. We will do everything possible to deliver the highest quality care in a safe and comfortable environment. We pride ourselves on great service. It is our desire to maintain a working relationship with your primary care Veterinarian and are available to them by phone or email.

Florida Veterinary Rehabilitation practices complementary medicine including veterinary physiotherapy, chiropractic therapy, acupuncture, herbals, and homeopathy. Our doctors have studied extensively in these subjects and will verbally inform you on the benefits and risks associated with these treatments.

Please do not hesitate to ask any questions you have about our services and office policies. And, if you are satisfied with our office and the service you receive, please tell a friend. We welcome new clients and appreciate it when our clients refer their friends and family to us.
Authorization and Missed Appointment Policy
Please provide your signature* as authorization to release/obtain vaccine information an medical records to or from other veterinary, grooming, or boarding facilities.

Missed Appointment Policy

We make every effort to accommodate your scheduling needs. In return, we ask that you help us by keeping your scheduled appointments, arriving on time, and notifying us a minimum of forty-eight (48) business hours in advance if you are unable to keep an appointment. Late arrivals, appointment cancellations with less than 48 hours’ notice, and no-shows may incur Missed Appointment Fees as follows:

1. First missed appointment: Our staff will call to make sure you and your pet are all right and to reschedule your appointment. You will not be charged for this first missed appointment.

2. Second missed appointment: Our staff will call to make sure you and your pet are all right and to reschedule your appointment. A $50 missed appointment fee will be charged to your account for every scheduled missed appointment. (acupuncture, laser, and underwater treadmill= $150)

3. Third and further missed appointments: Our staff will call to make sure you and your pet are all right. Immediate payment of the standard fee for the missed appointment will be required and must be paid before we will reschedule any further appointments. You will also be asked to pre-pay for any future appointments.

We realize that sometimes mistakes happen, and occasionally, appointments are missed. As a courtesy, the first-time waiver has been provided for such slip-ups. The above fees will be assessed per pet in cases of multiple-pet appointments. Fees may be waived at the Practice Manager’s discretion, she can be contacted regarding the cancellation fee at carrie@flvetrehab.com
I have read and agree to the above Policies and Authorizations for my pet care: *

Clear
Photo Release
Florida Veterinary Rehabilitation often photographs and videos patients while at FVR for the purpose of education, promotion or advertising. Please select on of the following: *

I authorize FVR to use my pet's image or likeness for the above purposes.I DO NOT authorize FVR to use my pet's image or likeness for the above purposes.My pet has a social media account that FVR should follow! tell us your handle in the "Other" field belowOther
Should be Empty:

FVR Policies

Authorization and Missed Appointment Policy

Photo Release