New Client & Pet Service Form
Welcome to Vet Tech 2 U!
Hello new friends! Before filling out the form below, please take a moment to read and understand our Company's Terms & Conditions (down below). Once reviewed, click agree to continue. Reminder: CATS & DOGS ARE REQUIRED TO HAVE A UP TO DATE RABIES CERTIFICATE BEFORE BEING ABLE TO SET UP AN APPOINTMENT (unless your veterinarian exempts the rabies vaccine). If you have any questions, do not hesitate to contact via text/call (772) 245-6657.
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CLIENTÂ INFORMATION
Owner's Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MILEAGE FEE
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I acknowledge that a mileage fee will be applied to each appointment, based on the distance traveled to the service location. This fee will be added to the total cost of the appointment and reflected on the final invoice.
PRIMARY VETERINARIAN
Veterinary Clinic/Hospital Name
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Phone Number
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Please enter a valid phone number.
Were you referred by said clinic/hospital?
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Yes
No
PET(S) INFORMATION
Do(es) your pet(s) have pet insurance?
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Yes
No
I prefer not to say
If yes, which insurance company? If none, please type 'none' or 'prefer not to say.' Note: we ask this question because some insurance companies will cover certain services.
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PET'S NAME #1
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File Upload
Your Pets Selfie Here
Drag and drop files here
Choose a file
Cancel
of
Species
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Please Select
Canine
Feline
Pocket Pet
Reptile
Amphibian
Avian
Large/Farm Animal
Aquatic
Breed
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Pet's Age/D.O.B.
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Color(s)
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Gender
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Male
Female
Male Neutered
Female Spayed
Temperament
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Friendly
Nervous but friendly (not likely to bite)
Caution - Fearful/Nervous (likely to bite/nip)
Caution - Aggressive (will bite [don't worry, no judgement - we just need to know])
Would this pet require to bring an assistant?
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Yes
No
Unsure
Does said pet require calming support? (Gabapentin, Trazadone, CBD/Hemp, etc...)
Yes
No
Unsure
Pet #1: Please share concerning health condition(s), if any. If none, please type 'None at this time.'
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Anything you wish to share about Pet #1? We love their quirks!
Please upload Rabies Certificate here for Pet #1 (ONLY REQUIRED for cats and dogs - if your veterinarian has exempted the rabies vaccines, please upload the exempt letter here)
PET'S NAME #2
File Upload
Your Pets Selfie Here
Drag and drop files here
Choose a file
Cancel
of
Species
Please Select
Canine
Feline
Pocket Pet
Reptile
Amphibian
Avian
Large/Farm Animal
Aquatic
Breed
Pet's Age/D.O.B.
Color(s)
Gender
Male
Female
Male Neutered
Female Spayed
Temperament
Friendly
Nervous but friendly (not likely to bite)
Caution - Fearful/Nervous (likely to bite/nip)
Caution - Aggressive (will bite)
Would this pet require to bring an assistant?
Yes
No
Unsure
Does said pet require calming support? (Gabapentin, Trazadone, CBD/Hemp, etc...)
Yes
No
Unsure
Pet # 2: Please share concerning health condition(s), if any. If none, please type 'None at this time.'
Anything else you wish to share about Pet #2? Are they an angel, a troublemaker, or both?
Please upload Rabies Certificate here for Pet #2 (ONLY REQUIRED for cats and dogs - if your veterinarian has exempted the rabies vaccines, please upload the exempt letter here)
PET'S NAME #3
File Upload
Your Pets Selfie Here
Drag and drop files here
Choose a file
Cancel
of
Species
Please Select
Canine
Feline
Pocket Pet
Reptile
Amphibian
Avian
Large/Farm Animal
Aquatic
Breed
Pet's Age/D.O.B.
Color(s)
Gender
Male
Female
Male Neutered
Female Spayed
Temperament
Friendly
Nervous but friendly (not likely to bite)
Caution - Fearful/Nervous (likely to bite/nip)
Caution - Aggressive (will bite)
Would this pet require to bring an assistant?
Yes
No
Unsure
Does said pet require calming support? (Gabapentin, Trazadone, CBD/Hemp, etc...)
Yes
No
Unsure
Pet #3: Please share concerning health condition(s), if any. If none, please type 'None at this time.'
Anything else you wish to share about Pet #3? Please share those funny stories!
Please upload Rabies Certificate here for Pet #3 (ONLY REQUIRED for cats and dogs - if your veterinarian has exempted the rabies vaccines, please upload the exempt letter here)
Service Information
Where did you first learn about us?
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Please Select
Facebook
Instagram
Nextdoor
Google
Other Search Engine
Customer Review
Word of Mouth
In-Person
Family/Friends
If someone recommended you to us, we would love to know who!
Choose Preferred Form of Payment Option
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Invoice *recommended
Zelle
Check
If you chose invoice, okay to send via:
Text & Email
Email only
I authorize Vet Tech 2 U, LLC to take photographs, motion picture, videotapes, or other visual media of my pet(s) which may be used for: patient records, educational purposes which may include: sending the media to you to show for your education, showing the media to other associates of Vet Tech 2 U, LLC, publishing for social media purposes (Facebook, Instagram, Website, promotional material, etc.) and I also understand that there is no royalty, fee, or other compensation for such use. I agree to make no claim to them now or in the future, and release Vet Tech 2 U, LLC from any liability in connection with the approved use of these materials. I understand that is optional and if I elect to not agree, NO media of my pet will be taken by Vet Tech 2 U, LLC.
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Yes, I AGREE to the Photography, Videography and Social Media Waiver.
No, I DO NOT agree to the Photography, Videography and Social Media Waiver.
Signature
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Please give the site a moment to upload your information; it will let you know when it's done. Please do not click back.
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