• New Client and New Patient Form

    Shady Brook Animal Hospital
  • Format: (000) 000-0000.

  • SECONDARY/CO-OWNER

  • Is there a secondary owner (co-owner) you would like added to your account?*
  • NOTE: Adding a secondary owner to your account grants the co-owner authorization to present your pet(s) for treatment, make medical decisions, access records, and authorize consent and financial responsibilities. Would you like to continue?*
  • Format: (000) 000-0000.

  • PATIENT INFORMATION

  • Sex:*

  • OWNERSHIP

  • Was there more than one pet obtained?*
  • Was {patientName} quarantined?*
  • Are there any other pets in the household?*
  • Were these pets added to the household after {patientName}?
  • Were these pets quarantined?
  • Has {patientName} had any previous testing, treatment, or vaccines?*
  • Is {patientName} displaying any symptoms of illness or having any medical problems?*

  • ENVIRONMENT

  • What type of environment does {patientName} reside in?*
  • Where does {patientName} spend most of their time?*
  • Does {patientName} have availability of hide boxes, breeding boxes, nesting materials, or humidity boxes?*

  • EXERCISE/ACTIVITY

  • Does {patientName} travel?*
  • Is {patientName} ever boarded?*
  • Does {patientName} ever receive grooming or trimming services?*
  • Does {patientName} shed or molt?*
  • Have you noticed any behavior or activity changes with {patientName}?*

  • REPRODUCTIVE

  • Is {patientName} spayed or neutered?*
  • Has {patientName} ever bred?*
  • How many times?
  • How many successful pregnancies?
  • Have you observed any breeding behaviors from {patientName}?*
  • Is {patientName} an egg layer?*
  • Are these eggs consumed by humans?*

  • ELIMINATIONS

  • Have you observed any change in the amount or frequency of {patientName}'s eliminations or droppings?*
  • Have you observed any change in the quality or consistency of {patientName}'s eliminations or droppings?*
  • Has {patientName} had abnormal discharge?*
  • Have you observed any blood in {patientName}'s eliminations or droppings?*

  • AUTHORIZATIONS, HOSPITAL POLICIES, PREVIOUS RECORDS, AND PATIENT PHOTO

  • Do we have your permission to share {patientName}'s image and story on our social media, website, and other forms of related media?*

  • Hospital Policies

  • THIRD-PARTY PHARMACY PRESCRIPTIONS AND REQUESTS:

    We understand that there are many reasons our clients may want to purchase medications from online retailers or outside pharmacies. To assist you in making the most informed decision for your pet, we want to be very clear that we recommend that you purchase products only from a properly accredited and certified veterinary pharmacy.

    However, if you choose to procure medications from an outside source, we want to give you that option.

    Clients who opt to obtain their pet’s medication from outside pharmacies will simply need to pick up a written prescription at OUR HOSPITAL. Shady Brook Animal Hospital will not call in prescriptions or process orders for medications or preventatives sent directly to us (via phone or fax) from online suppliers or from outside pharmacies.

    We absolutely support our client’s choice to choose where they obtain their pet’s medications and are happy to accommodate a request to do so.

    Why did we institute this protocol?

    We did so for a few reasons listed below:

    First, we are choosing as a clinic to spend our time focusing on taking care of our patients and clients instead of answering faxes and calling pharmacies. We are finding that some prescription refills are being prompted by the online pharmacy, not the pet owner, and this causes much confusion and is very time-consuming to identify.

    Second, we feel it is better medicine with written documentation of an original prescription that is filled outside of our clinic. There are more concerns with the possibility of prescription errors when relaying information over the phone.

    We understand that cost is a big reason that our clients purchase from outside pharmacies and online retailers. We do our very best to make our medications and preventatives affordable, and we routinely compare prices online to make sure that our prices are competitive.

    We would like to encourage our clients to order medications and preventatives directly from us through direct purchase at our clinic or from our own online store. Because our online store is part of our clinic infrastructure, you will not need a written prescription if you order this way.

    Our clinic and online store’s supply chain is 100% secure. From the time the medication is manufactured, all the way to when you are going to give it to your pet, it has been handled, stored, and packaged in compliance with manufacturer guidelines. The product you receive is guaranteed to be the name-brand medication in the proper dosage and packaging. Medications purchased directly from our online store and us are guaranteed by the product’s manufacturer and, most importantly, by us, your pet’s veterinarian.

  • Date
     - -
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Pet Photo:

    Please feel free to upload your favorite picture of {patientName}, and we will update {patientName}'s hospital chart to include their photo.

    *This photo will not be used for any other purpose than the patient's hospital chart. Uploading a photo does not give the hospital permission to use this photo on any social media accounts.

  • Should be Empty: