ICC New Client Paperwork 2023

Isabella Cat Clinic, PC Catherine Lindstrand, DVM

1635 E. Broomfield St., Suite G Mt. Pleasant, MI 48858

Ph: 989-779-2700

Fax: 989-317-3032

New Patient/Client Information

Date*

Date

Owner's Name*

Spouse's/Others Name

Address*

Address

Street Address Line 2

City

Apartment/Suite Number

ST*

Zip*

Animal's Name*

Primary Phone Number (required)*

Secondary Phone Number

E Mail Address (required)*

example@example.com

Employer's Name

Approved name/phone number for medical release:

Social Security Number (required)

Driver's License Number (required)

We require either a SS number or DL number to be on file. We do not share your information with any other individual/business.

Professional fees are due at the time services are rendered. We do not bill.

All new clients are required to pay a $50.00 deposit to book their first examination. This deposit will go towards the overall cost of your virst examination. This deposit is non-refundable in the case of a no-call, no-show, or if you do not give a 48 hour notice for appointment cancellation.

We accept cash, personal checks, VISA/MC/AMEX, and CareCredit. A 3% discount is offered if you pay with cash/check.

I certify that the above information is true to the best of my knowledge. I understand that full paymentis due at the time of service. I also understand that if my account should become delinquent, I will be charged an 18% annual percentage rate. or a minimum of $2.00 billing fee per month. whichever is greater. All returned checks will be assessed a $25.00 service charge. There is a S50 service fee for all no call/no show appointments. To prevent the spread of infectious discases/parasites, hospitalized/boardc animals must be current on all vaccinations and free of internal/external parasites. I authorize the veterinarian to provide vaccines and parasite control as needed for my pet.

Signature*

Clear

Date*

Date

Cat's Name*

Gender*

Spayed/neutered?*

Age*

Color*

Recommended Tests/Services Waiver

Feline Leukemia/FIV Combo Test: $68.00

We strongly recommend feline leukemia/fiv testing for all patients. These are autoimmune disorders that they can get from other infected cats or from their mother when developing. Cats with feline leukemia tend to be very sick more often and have shortened lifespans. Cats with FIV can live long and healthy lives; they just require more supportive care when they become ill.

Comprehensive Fecal Analysis & Parasite Screening: $58.00

We also recommend checking a fecal sample on all patients annually as parasites can contribute to a number of illnesses. If checking a stool sample please bring the sample to your appointment. It doesn't matter what you bring it in or if it has litter on it. Simply collect the sample the night before or day of your appointment.

Bartonella Test: $109.50

Bartonella testing is recommended for every patient over the age of 8 months, but it is highly recommended if anyone in the household is immunocompromised. Bartonella is a bacteria that cats can get from fleas and then give to humans through scratches. Approximately 33% of all cats in the US test positive and have to undergo treatment.

Heartworm Test: $68.00

Cats can get heartworm disease just like dogs, however, heartworm disease is not curable or treatable in cats. There is a blood test that can determine if your cat has been exposed. Monthly flea and heartworm prevention is also strongly encouraged.

Revolution Plus: $20.90

We strongly encourage all patients, regardless of their lifestyle, be kept on monthly flea and heartworm preventative. Revolution Plus prevents fleas, heartworm, roundworm, hookworm, ear mites and ticks.

Leukemia/FIV Testing*

I would like this test completed at my cat's first visit.I would like to decline this test.

Comprehensive Fecal Analysis & Parasite Screening*

I would like my cat to be tested for intestinal parasites and giardia.I would like my cat to be tested only for intestinal parasites.I would like to decline these tests.

Bartonella Testing*

I would like this test completed at my cat's first visit.I would like to decline this test.

Heartworm Testing*

I would like this test completed at my cat's first visit.I would like to decline this test.

Revolution Plus*

I would like my cat to have a dose of Revolution at their first visit.I would like to decline this service for my cat.

By signing below, I do hereby certify that an Isabella Cat Clinic staff member has informed me about the risks of vaccine sarcomas, feline heartworm disease, Bartonella, and feline leukemia/FIV. I also certify that I have been spoken to about the recommendation for screening for intestinal parasites. I understand the risks of declining any of these services against my veterinarian's recommendation, and understand that these services can be done in the future if I so choose.

Owner's Name*

Animal's Name*

Signature*

Clear

Date*

Date

Spay/Neuter, Annual Exam & Vaccination Waiver

It is Dr. Lindstrand's personal practice philosophy that all patients be spayed or neutered, current on all age appropriate vaccinations and receive annual examinations to ensure the health and safety of your pet from any infectious diseases, the health and safety of our existing clients and their pets, and the health and safety of our staff that care for your pet during each visit.

I understand that the Isabella Cat Clinic requires all patients to be spayed or neutered in order to be patients and receive services through the clinic. Spay and neuter promotes responsible pet ownership.

I understand that the Isabella Cat Clinic requires all patients to have annual exams once every twelve months to remain active patients. Annual exams allow us to more accurately assess your cat's health and address issues as they arise.

I understand that the Isabella Cat Clinic requires all patients to have annual vaccinations in order to remain active patients and receive services, This ensures the safety of your pet, our staff, and the other pets receiving care through our facility.

We strive to treat our clients with kindness and respect and we ask for the same treatment in return. If either party feels that the relationship is no longer positive or productive they can opt to sever the doctor/patient relationship. In these instances you will be sent with or mailed a copy of your animal's complete chart.

By signing/initialing below, I do hereby certify that an Isabella Cat Clinic staff member has informed me about the spay and neuter requirement and the annual vaccination and annual exam requirements. I understand that failure to fulfill these requirements will make me an inactive client and therefore unable to bring my cat in for problem exams, emergency services or prescription food and/or drug needs.

Owner's Name*

Animal's Name*

Signature*

Clear

Date*

Date