New Client Application

New Client Application

This application, along with the following Patient Registration Form, allows Dr. Rice to thoughtfully determine whether her personalized, in-home veterinary care is the right fit for your pet and family. Thank you for taking the time to complete it. We are honored to be considered for your pet's care.
Primary Name*

First NameLast Name
Primary Email*
example@example.com
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
I consentNo I do not consent, and thus withdraw my application
YesNo, Email Only
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gate code
Please indicate where we should park when we arrive.*
Would you like to add a second person to your account? If yes, please type their name and relationship to you below. You may also include their phone number and email.*
What is most important to you regarding overall medical care for your pet?*
How did you hear about us?*
Exam/consultationVaccinations/vaccine titersEvaluation of an illness or injurySecond opinionTreatment or testing for valley feverKitten/puppy careSenior/geriatric carePain managementLaser therapy/PEMF therapyAnxiety/behavioral concernsNutrition/weight managementHormone replacement therapyBloodwork or other laboratory testsReferral for imaging, dental care, or surgeryMedications or refillsOther
Yes, I consentNo, I do not consent
As part of our commitment to transparency, we invite you to review our general pricing by clicking here.
To help you understand what to expect when partnering with Dr. Woof’s Veterinary Care, please review our Client Service Agreement and Consent to Treatment by clicking here.
Before We Continue, Please Review and Confirm the Following:
I understand that after submitting this form, I will be automatically redirected to complete the Patient Registration Form before moving forward in the onboarding process.I understand that timely submission of my pet’s medical records, as outlined in the Patient Registration Form, allows Dr. Woof’s Veterinary Care to thoughtfully plan my visit and prepare an accurate estimate, and delays in receiving records may impact appointment scheduling.I understand that completion of forms does not guarantee establishment of care by Dr. Woof's Veterinary Care.By checking this box, I confirm that I have reviewed the general pricing information using the link above.By checking this box, I confirm that I have reviewed the Client Service Agreement and Consent to Treatment Form using the link above.I understand that if services are determined to be an appropriate fit, I will be asked to electronically sign the Client Service Agreement and Consent to Treatment Form prior to scheduling. I also understand that I will receive a personalized estimate via email for electronic signature.I understand that appointments are confirmed only after all onboarding steps have been completed, and delays in paperwork may impact scheduling availability.I understand that Dr. Woof's Veterinary Care does not offer emergency care, evening or weekend availability, and is closed major holidays.I understand that Dr. Woof's Veterinary Care only provides service to homes free of cigarette and marijuana smoke and this includes homes where smoking has occurred recently or regularly in the past. In addition we will not perform service at homes where individuals are visibly impaired by alcohol and/or drugs.I understand that if I am an acquaintance, friend, or family member of Dr. Rice, all policies, prices, and communicated boundaries apply to me, as for any other client of Dr. Woof's Veterinary Care.
By signing the box below and submitting this form, this verifies understanding and accurate completion of this form.*
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