Our House Call Vet : Registration Form

Owners full name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Number *

area codenumber

e-mail address*

How did you hear about us, or who referred you?*

Pets Name *

Breed and color*

Weight*

Pets birthdate / age*

Is pet a male or female? *

Reason for appointment (if a sick visit, please briefly describe symtoms*

What was the date of the last rabies vaccination*

Regular Veterinary Hospital name*

At the veterinary clinic, do they bite, scratch, jump or try to run away or hide? Do they usually need anxiety medication or a muzzle to go to the vet? How is your pet with strangers coming into the home?*

I have read the client policy below. PLEASE MAKE SURE TO CLICK SUBMIT button

CLIENT POLICY: PAYMENT IS DUE AT THE TIME THAT SERVICES ARE RENDERED. We accept cash, check, or zelle and credit cards *

Dr. Mazzola and staff are happy to assist you and your pet in a mutually enjoyable and respectful working relationship with healthy boundaries. Dr. Mazzola is a proud supporter of Not One More Vet and reserves the right to refuse service at her discretion. AGGRESSIVE PET POLICY Due to some staff injuries and safety purposes OHCV has a no aggressive pet policy. We reserves the right to decline a physical exam if a pet displays aggressive behavior, such as growling, snarling, lunging or attempting to bite. If the pet is deemed to be aggressive by the veterinarian, the client agrees to pay in full, the house call and travel fee and a veterinarian consultation fee. OHCV does not accept pets with a history of fear or other aggression or pets in need of sedation/muzzles for exams. Dr. Mazzola reserves the right to refuse service at her discretion PREVIOUS RECORD AUTHORIZATION: I authorize Our House Call Vet to contact my previous veterinarian to obtain records, doctors notes, and lab test results. CONTACTING OHCV: Due to the nature of this practice, Dr. Mazzola’s preferred method of contact is email as they are either actively with a patient or actively traveling for housecalls. TELEMEDICINE APPOINTMENTS are available for continued correspondence and care after the in person appointments, and will be charged according to the amount of time involved in the telemedicine consult.