Please CALL us upon your arrival at MVER.

603-279-1117

We recognize that this is a stressful time for you and your family and understand that the human-animal bond is priceless.

Like most veterinary practices across the country, MVER is caring for a significantly greater number of patients since 2020. In order to provide prompt, efficient care to our patients and clients, MVER is currently operating on a hybrid exam room/curbside model. Currently our facility does not offer enough space to invite every single client and patient into the building for the duration of your visit. Our exam rooms are reserved initially for clients and patients with the most serious, potentially life-threatening conditions, and for those families making end-of-life decisions. Then, if space allows, those clients and patients with less urgent conditions may be invited in. Stable patients may remain entirely curbside. We appreciate your patience and understanding in this process.

Patients are triaged upon arrival and those who are critical or emergent will always be our priority (see TRIAGE chart below). We assure you that while your pet is inside our hospital, they are within the eyesight of our highly trained team who have your pet’s best interest at heart. Here at MVER, we are committed to providing the highest quality medicine and will continue to adapt to the ever-changing needs of our patients in every way possible. For us to properly focus on the needs of the most critical patients, non-emergent cases will experience longer wait times. Understand that we provide emergent care. We do not provide preventative care or manage chronic issues.

Thank you for waiting and respecting the families of patients, and the patients themselves, whose lives are on the line, where seconds can count.

ZERO TOLERANCE POLICY

Our entire staff treats every patient and client with the respect and humanity that is deserved. No one has the right to verbally abuse, raise their voice, or get physical in any capacity with our staff members. It is your responsibility to control your actions and emotions. All staff supervisors have been granted the right to ask you, your family or members of your party, and your pet to leave immediately without the opportunity to return to seek out services from this company above and beyond immediate triage for critical situations. This action will be taken if any staff member has been verbally or physically assaulted or has been treated inappropriately such that they are made to feel unsafe, devalued, disrespected, or publicly humiliated by you or a member of your party. If such action is taken, treatment if any has been performed, will be immediately discontinued. Within five business days of the action taken, a letter will be mailed from this office to the residence listed, with a formal termination of a relationship with this facility for any services above and beyond immediate triage for critical situations.

Your signature below acknowledges that all services, including life-saving services, will not be rendered without an agreement to the Practice Policy:

I acknowledge that MVER has a ZERO TOLERANCE POLICY for the abuse of their staff. Verbal or physical abuse or any behavior deemed by the MVER team as inappropriate toward the staff will result in the formal termination of a relationship with this facility and any personnel who have privileges to practice or are currently or formally employed within. I recognize that I have received notice as to what the consequences of my actions are in this physical form. I acknowledge that the decision for termination is the sole discretion of the MVER team and supervisor on duty and will not be overturned by management except in cases of gross misconduct by an employee.

Signature*

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Date*

Date

Client Name (Person)*

First NameLast Name

Spouse/Other Name

First NameLast Name

Are you the legal owner of this pet and at least 18 yrs of age? *

Yes / No

Have you arrived at MVER yet? If not, what is your estimated time of arrival?*

Parking Spot / Car Description

Home Phone Number *

Area CodePhone Number

BEST Phone Number to be reached at TODAY: *

Area CodePhone Number

Cell Phone Number *

Area CodePhone Number

Please select all that apply.*

I, or someone in my household, have tested positive for COVID-19 in the last 7 days.I have been experiencing cold/flu symptoms.I have been exposed to COVID-19 or someone with it.None of the above

Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Pet's Name*

Species *

Cat / dog / other

Breed*

(cats - Domestic Shorthair, etc)

Birthdate or approx age*

Gender*

Male / Female

Spayed/Neutered*

Yes / No

Pets' Approximate Weight Today:*

Color*

What is the reason for your visit today?*

When did the problem begin?*

Has this animal had any medication or supplements in the last 24 hours?*

NoYes, please list below

Medications:

Does this pet have any significant medical history (chronic issues, past surgeries or hospitalizations, etc)?*

Has this animal bitten anyone in the last 10 days? If yes, who was bitten and what were the circumstances?*

Is this animal up to date on vaccinations, in particular, a Rabies Virus vaccination?*

Tell us about this pet's diet/eating habits - what type of food, how often, when did s/he last eat?*

Does this animal live mostly indoors, mostly outdoors, or both?*

Please list any other pets in the household that this pet is exposed to:*

Has this animal ever had any seizure activity? If yes, please explain:*

May we utilize photos of your pet for social media/educational posts?

Yes, please!No, thank you

Has this animal ever had a need for pre-medication or muzzles due to aggressive behavior at a veterinary hospital? Please explain:*

Does this animal have any history of allergies to medications or reactions to anesthesia of which you are aware?*

Is this pet covered under any pet insurance?*

YesNo

What veterinary hospital does your pet visit for routine care?*

What is the address of your FAMILY VETERINARIAN?

Is there anything else we should know regarding your pet?*

WE APOLOGIZE FOR THE INCONVENIENCE BUT WE CANNOT ACCEPT CHECKS AS PAYMENT. How do you plan to pay for today's visit?*

Signature of Recognition:

I, the undersigned, give permission for the doctors and staff of the Meredith Place Veterinary Emergency Hospital (MVER) to evaluate the above-named animal (Patient). I assume financial responsibility for all charges incurred and agree to pay all such charges at the time services are rendered. I also understand that checks or third-party credit cards cannot be accepted. I am responsible for interest and collection fees on any unpaid balance. I am 18 years of age or older.

Date*

Date

Signature*

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CALL US UPON ARRIVAL
603-279-1117

Texting will result in potential wait times.

EMERGENCY PATIENT CHECK-IN

Practice Policy

CLIENT / OWNER INFORMATION

PATIENT / PET INFORMATION

Family Veterinarian Information

CALL US UPON ARRIVAL
603-279-1117

EMERGENCY PATIENT CHECK-IN

Practice Policy

CLIENT / OWNER INFORMATION

PATIENT / PET INFORMATION

Family Veterinarian Information

CALL US UPON ARRIVAL603-279-1117

CALL US UPON ARRIVAL
603-279-1117