New Client Appointment Request Form

New Client Appointment Request Form

Your next step to compassionate feline vet care right in the comfort of your own home!
Disclaimer: We do not see emergencies. If your cat is experiencing a life-threatening condition, please contact your nearest veterinary emergency hospital. Please see website FAQs under “Do you see emergency cases?” for a list of ER vet hospitals in our service areas. If in doubt, please contact us at info@gentlewhiskers.com*

I understand and agree
Please ensure you're within our service areas (https://www.gentlewhiskers.com/service-areas) and please review our pricing (https://www.gentlewhiskers.com/pricing) prior to filling out this form.*

I understand and agree
Primary Owner Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Date of Birth*

MonthDayYear
Date
Occupation/Profession
Secondary Owner Full Name

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Date of Birth

MonthDayYear
Date
Occupation/Profession
Relationship to Primary Owner
Address (Location of House Call Visit)*

Street Address

Street Address Line 2

CityState

Zip Code
How many cats do you have? How many cats would you like seen during this visit? (You only have to provide the particulars of the cat(s) you wish to be seen for this visit.)*
Cat #1 Name*
Cat #1 Estimated Date of Birth*

MonthDayYear
Date
Cat #1 Breed (Predominant)*
Cat #1 Color(s)*
Cat #1 Estimated Weight in lbs*
Cat #1 Indoor/Outdoor Status*

Indoor onlyIndoor / outdoorOutdoor only
Cat #1 Spay/Neuter Status*

Male IntactMale NeuteredFemale IntactFemale SpayedUnknownLitter
Cat #2 Name
Cat #2 Estimated Date of Birth

MonthDayYear
Date
Cat #2 Breed (Predominant)
Cat #2 Color(s)
Cat #2 Estimated Weight in lbs
Cat #2 Indoor/Outdoor Status

Indoor onlyIndoor / outdoorOutdoor only
Cat #2 Spay/Neuter Status

Male IntactMale NeuteredFemale IntactFemale SpayedUnknown
Enter all required information below for 3rd cat or more. If litter, enter under Cat #1 and state number of kittens below.
If you would like to provide photos of your furry felines for their patient profiles, please attach them here. Each photo should show each cat individually, limited to one photo per cat. Please use their names as the file name.

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What type of appointment is this for? Select all that apply.*

Wellness exam and consultation (including vaccines)In-home sedation (injectable anesthesia)Ear issuesEye issuesNose/throat issuesOral/dental issuesHeart issuesRespiratory/breathing issuesSkin issuesGastrointestinal issuesUrinary issuesMusculoskeletal/mobility issuesNeurologic issuesBehavior consultationAcupunctureIn-home euthanasiaDomestic travel health certificatesOther
Please elaborate for the choice(s) selected above. How long have the clinical signs been going on for? Any other issues or concerns about your cats? What else do you need help with?*
Do you have any dogs at home?*

Yes, small breed onlyYes, medium to large breed onlyYes, both small and medium to large breedsNo
Do you have a separate quiet room or area in your home for the house call visit to take place for your cats?*

YesNoOther
Have your cats ever had a reaction to vaccinations? If yes, please elaborate.*
Are your cats on any monthly flea/tick/heartworm preventatives? If yes, please state brand of preventatives.*
Please list all medications and supplements your cats are currently taking. If possible, list dosage and frequency.*
Do any of your cats have a history of aggression or anxiety? Any known history of scratching or biting? Please describe in detail. This is important to determine if anti-anxiety medication/sedatives would be needed prior to the appointment.*
What type of services are you potentially interested in? Select all that apply. See www.gentlewhiskers.com for more details.*

Exam and consultationVaccinesMedicationsNutritionBehavior consultationIn-home sedation (injectable anesthesia)Acupuncture and integrative medicine (launching in 2026)Kitten careGeriatric careArthritis management/SolensiaWellness bundlesConcierge service/wellness plans (launching in 2026)Telemedicine appointments (for established clients)In-home euthanasiaDomestic travel health certificatesOther
Submission of previous medical records is required prior to scheduling the initial appointment. This includes exam notes, vaccination records and lab test results from a veterinarian. Invoices, breeder records, pet vaccine passports, and rabies tags are NOT considered medical records. If you have them, please attach below. If not, please contact every veterinary clinic your cat has received care to forward medical records to info@gentlewhiskers.com promptly.*

I will attach the medical records belowI will get my previous clinic(s) to forward records to info@gentlewhiskers.comI do not have any previous medical records. I understand that my cat will have to restart the series of all vaccinations.Other
Previous Medical Records

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Please list all previous veterinary clinics you will be forwarding medical records from.
May we use photographs, videos/motion picture and/or other media of your cats on our social media platforms and newsletters?*

YesNoOther
Please select your preferred payment method. Our preferred payment method is Zelle, and you may be offered a small discount for using it. We do not accept cash, check, CareCredit, Scratchpay, etc.*

Zelle (preferred)Credit/debit card (Visa, Mastercard, American Express, Discover, Apple Pay)
If using Zelle, what is your Zelle ID? It's either a phone number or email address.
How did you hear about us? If you were referred to us, please state who referred you.*
Please describe directions to park near your home.*
Please describe directions to access to your housing unit. If you live in a gated community, please provide callbox instructions or any access codes.*
Terms & Conditions
Submission of this form is considered a request. Someone will reach out via the email address provided within 1-2 business days to start the appointment confirmation process. Based on the information provided, we reserve the right to refuse service to anyone for any reason.*

I understand and agree
As the whole initial appointment confirmation process (including consent paperwork, deposit collection, medical records forwarding) takes some time, this request must be made a minimum of 3 business days in advance.*

I understand and agree
A full deposit of the travel and exam/consultation fees are required prior to confirmation of the initial appointment. This fee is refundable up until 24 hours prior to your appointment time.*

I understand and agree
Vaccines, lab tests, medications and other services are NOT included in the fee deposit for the initial appointment. All charges for services rendered are due and payable in full at the time of service, regardless of whether you have pet insurance. We do not accept CareCredit or Scratchpay.*

I understand and agree
As part of our low stress/fear-free approach to handling cats for vet visits, your cats are recommended to be given pre-visit pharmaceuticals (PVP; i.e., oral anti-anxiety medication) prior to appointments. Please let us know if you are interested in this.*

I understand and agree
In accordance with WA state laws, all pet cats must have up-to-date rabies vaccination. Cats without proof of a rabies certificate signed by a licensed veterinarian will be required to get a rabies vaccine during the appointment.*

I understand and agree
Submission of previous medical records is required prior to confirmation of the initial appointment. If no records are available, your cat will have to restart the series of all vaccinations.*

I understand and agree
We do not offer emergency care in any capacity, including to established clients.*

I understand and agree
All house call and telemedicine video call appointments include a 60 min estimated time of arrival window.*

I understand and agree
We have a zero tolerance policy for abusive behavior by clients. In the event a client engages in any such behaviors, we will discontinue services immediately.*

I understand and agree
Please verify that you are human*
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New Client Appointment Request Form

Terms & Conditions