Current Patient Appointment Request

Special Policies for Respiratory Infections
To protect the health of our clients and staff, and minimize risk of disease exposure or transmission from infectious diseases, Veterinary Wellness Center has enacted the following policies.
1. We are continuing our rigorous disinfection of all contact surfaces throughout the clinic with Rescue, which has efficacy against the Coronavirus that causes COVID-19.
2. Masks are optional.
3. If you are feeling ill, have a fever above 100*F, or have been diagnosed with a contagious respiratory disease (including COVID-19 or the flu) within the past 5 days, please contact us to reschedule your appointment. You can also have someone else bring your pet to the clinic.
We thank you for your patience and assistance in keeping everyone as healthy as possible.

VWC management will not tolerate any belligerant, rude, or aggressive behavior regarding our any of our policies.
Do you or any members of your household have symptoms of respiratory disease, a fever over 100*F, or a positive COVID or Flu test within the past 5 days?*

YesNoNot sureOther
By continuing and submitting this form, you are agreeing to comply with Veterinary Wellness Center's infectious respiratory disease protocols.

Clinic Policies
I have read and agree to the policies for late arrival, cancellations and missed appointments.
YesNo
I have read and agree to the policy on low stress handling.
YesNo
I authorize the Veterinarians and Staff of Veterinary Wellness Center (VWC) to examine my pet and provide medical care. I assume full financial responsibility for all authorized charges.

I have also been made aware of, and agree to, the following VWC policies:
- All payments are due in full at the time services are rendered. We accept Cash, Check with ID, Credit Cards, and CareCredit.
- For their safety, all pets are required to be on a leash or in a carrier at all times.
- If your pet is coming in for health concerns, preventative care may be delayed untill health concerns are fully addressed and treated by the care team.
By continuing with this form, I certify that I have read and agree to the VWC Informed Consent Policy.

Illness History
Please list your concerns about your pet's health:*
When did the problem(s) start?*
Since you noticed it, is the problem getting:*

BetterWorseAbout the same
Has this problem happened before?*

YesNoNot sure
Please list any treatment that has been done for this problem, and if it helped:*
Do any other pets have similar symptoms?*
Do you have any other concerns or observations about your pet you would like addressed?

General Medical History
Has your pet been seen at another veterinary clinic since their last visit with VWC?*

YesNoOther
If yes, please list the name(s) of the veterinary clinic(s) so records can be requested.
When was prevention for heartworms and intestinal parasites last given?
When was prevention for fleas and ticks last given?
Please list all foods, treats and supplements your pet is eating at this time. Include approximate amounts if possible.
Do you think your pet has any food allergies or intolerances?*

YesNoNot sure
Please specify your pet's dietary restrictions:
Please list all medications your are currently giving your pet. Include dosage strength and frequency if possible.
As of 03/03/2021 deposits will be required for all appointments as this reduces no-shows and last-minute cancellations that impact our ability to care for all patients. This is refundable only if you cancel with at least 48 hours notice. By clicking submit you are acknowledging that you are aware of our cancellation policy.
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Current Patient Appointment Request Form