Furmery First Visit Form
  • Furmery First Visit Form

    Welcome to Furmery! This initial intake form helps us get to know you better, and allows us to care foryour pet through integrative veterinary medicine—combining traditional and holistic approaches withcompassion, intention, and respect. May God bless your Fur-mily!
  • SECTION 1: Fur Parent Information

  • Format: 0000 000 0000.
  • Preferred Method of Contact*
  • SECTION 2: Pet Information

  • Species*
  • Gender*
  • Spay/Neuter Status*
  • Birthday
     - -
  • SECTION 3: Lifestyle & Diet

  • Please describe your pet's current diet*
  • Frequency of feeding
  • SECTION 4: Medical History

  • SECTION 5: Traditional Chinese Veterinary Medicine (TCVM)

  • Have you done any TCVM Consultation or Insights?*
  • SECTION 6: Your Pet's Personality & Preferences

  • Temperature Preference (Which does your pet gravitate towards?)
  • Thirst Level
  • Personality Type
  • SECTION 7: Holistic History

  • Has your pet ever received any of the following holistic treatments? (Select all that apply)*
  • SECTION 8: Spiritual Care

  • SECTION 9: Consent & Liability Agreement

  • I confirm that the information I provided is true and accurate to the best of my knowledge, and I authorize Furmery to examine and provide veterinary care to my pet. I understand that recommended examinations, diagnostics, treatments, and possible monitoring or hospitalization will be explained during the consultation. I acknowledge that no outcome is guaranteed, and understand that I may decline treatment at any time except in cases of medical emergency, where immediate care may be provided if deemed necessary by the veterinary team to protect my pet's life or welfare. I agree to release Furmery and its affiliates, owners, veterinarians, and staff from any and all liabilities.
  • Care Consent*
  • To provide added learning and inspiration for pet-caretakers, I give permission for Furmery to share my pet's story, photos, videos, or testimonials for educational or informational purposes, including on social media, the website, and all other clinic materials. I understand that my pet's name may be mentioned, but no personal contact information will be shared. I acknowledge that shared content is not a guarantee of medical outcomes, may be reshared by others once published, and that while I may request future removal, complete removal from all platforms cannot be guaranteed. I agree to release Furmery and its affiliates, owners, veterinarians, and staff from liability related to the respectful and good-faith use of this content.
  • Photo & Story Permission*
  • Should be Empty: