Client Information Form

Brooklyn Yard Veterinary Hospital Client Information Form
Thank you for taking the time to read and submit this form!

The end of this form may look like a lot of information, but we want you to feel prepared for your visit and have a thorough understanding of our important clinic policies.

We are dedicated to providing exceptional care to you and your pets! Please call or email us with any questions or concerns that may arise.
APPOINTMENT CHECK-IN:

Our check-in process is a little different than other places due to considerations for our more sensitive patients, and to help keep the stress levels down in general for both people and animals. Because of this, we keep our front door locked at all times.
- For the comfort and safety of all our patients, we check in every appointment curbside over the phone!
  Please park in front of or close to the clinic, remain in your car, and give us a call to check in. A member of our team will come out to greet you and your pet and welcome you inside.
- Please do not wait by the entrance or crowd the sidewalk. Some of our patients are fearful or people/dog reactive.
- Please secure cats safely in a carrier and keep your dog on a leash at all times.
- We kindly ask that prong and/or electric collars (e-collars) be removed before entering our facility.
CLIENT DETAILS
Primary Contact*

First NameLast Name
Pronouns
*Not required, share if you'd like to!
Phone Number*
Format: 000-000-0000.
E-mail*
example@example.com
Preferred Method of Contact

PhoneTextEmail
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Contact

First NameLast Name
Pronouns
*Not required, share if you'd like to!
Phone Number
Format: 000-000-0000.
Email
example@example.com
Preferred Contact Methods

PhoneTextEmail
We utilize text messaging as our primary method of confirming appointments. Please indicate which contact would like to receive appointment reminders.

*Please note we cannot text both contacts
Please Text:*

Primary ContactSecondary ContactI prefer a phone call
We utilize e-mail as our primary method of veterinarian/client communication, and for sending healthcare reminders. Please indicate which contact would like to receive these emails.
Please Email:*

Primary ContactSecondary ContactBoth
How did you hear about us?*
*if a trainer or a local business recommended us, please provide their name below so we can say thank you!
Other
Any other info we should know?
PATIENT DETAILS
Patient name*
Patient species*
Patient breed*
Color*
Age*
Approximate age or birth date if known
Patient is a*

Spayed FemaleNeutered MaleIntact FemaleIntact Male
Add Additional Pet(s)?

Yes!
- ADDITIONAL PET
- Patient name
- Patient species
- Patient breed
- Color
- Age
  Approximate age or birth date if known
- Patient is a
  
  Spayed FemaleNeutered MaleIntact FemaleIntact Male
- Add Additional Pet(s)?
  
  Yes!
- ADDITIONAL PET
- Patient name
- Patient species
- Patient breed
- Color
- Age
  Approximate age or birth date if known
- Patient is a
  
  Spayed FemaleNeutered MaleIntact FemaleIntact Male
- Add Additional Pet(s)?
  
  Yes!
- ADDITIONAL PET
- Patient name
- Patient species
- Patient breed
- Color
- Age
  Approximate age or birth date if known
- Patient is a
  
  Spayed FemaleNeutered MaleIntact FemaleIntact Male
- Any other general info we should know about your pet(s)?*
  *Please be brief!! For medical information pertaining to your appointment, please do NOT include here. Please add those details to your pet's Pre-Appointment Form
- Please list all previous veterinary clinics that your pet(s) have been seen at. Include full name of the clinic with the location AND possible pet/contact information those records would be under. We will need to obtain previous records BEFORE your appointment.*
- Consent & Policies
  
  Please read and review carefully. Let us know if you have any questions!
- PRESCRIPTION POLICY:
  
  Brooklyn Yard Veterinary Hospital WILL NOT process (phone, email, fax etc.) prescriptions to or from outside and online pharmacies (with the only exception being for medications that need to be compounded).
  
  We support our client's choice to choose where they obtain their pet's medications and are happy to accommodate a request to do so.
  
  Clients who opt to obtain their pet's medication through these avenues will need to pick up a physical written prescription at our hospital.
  
  Please refer to our prescription policy on our website for more information: Brooklyn Yard Veterinary Hospital Prescription Policy.
- By signing here, I acknowledge that I have read and agree to the above stated prescription policy*
- LEASH AND CARRIER POLICY:
  
  Please make sure that your dog is safely secured on a leash when exiting your vehicle and coming into the clinic. We ask that you please refrain from using any type of aversive collar in our clinic (prong collar, electronic collar, etc.), and if you use a retractable leash, please keep it locked.
  
  All cats should be secured in an appropriate carrier when traveling from your car to the clinic - even if your cat is leash-trained! We are at a very busy intersection and often have other animals coming and going, so there is a chance for your kitty to become startled. If you do not have a cat carrier, please let us know! We have some you could borrow or cardboard ones for purchase.
- PHOTOGRAPHY
  
  There are a variety of reasons we might wish to use a photograph of your pet: educational materials, our website, or social media. Please select an option that you are comfortable with (we mainly use photos for social media!)
- Choose One:*
- APPOINTMENT CONFIRMATION/CANCELLATION POLICY:
  - We expect to receive client confirmation of all appointments no less than 12 hours prior to the appointment time or they are subject to cancellation.
  - If you are 10+ minutes late to your appointment, you will be charged a $30 late fee, and may be asked to reschedule.
  - If an appointment is missed completely (no-call/no-show), a non-refundable fee equal to the cost of the exam ($75-$115) will incur.
  AUTHORIZATION FOR MEDICAL TREATMENT
  
  I am the owner or owner’s agent over the age of 18 and authorize the attending veterinarian to provide medical, dental, and/or surgical procedures on the animal being admitted for care and hereby authorize the staff of Brooklyn Yard Veterinary Hospital to render any treatment that is deemed necessary to the health of my pet, and has been agreed to by me, while in the custody of the hospital. I understand that payment is due at the time of services rendered.
  
  I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me or my designated representative before, if time permits, proceeding with treatment. I understand that I will be financially responsible for all medical and emergency procedures, including the estimate of charges provided to me in person, by phone, or by email.
  
  We accept Cash, Mastercard, Visa, American Express & Discover. We also accept CareCredit and Scratchpay.
  
  We do not accept personal checks.
- Please sign here to acknowledge you accept our outlined policies*
- Should be Empty:

Brooklyn Yard Veterinary Hospital Client Information Form

APPOINTMENT CHECK-IN:

CLIENT DETAILS

We utilize text messaging as our primary method of confirming appointments. Please indicate which contact would like to receive appointment reminders.

We utilize e-mail as our primary method of veterinarian/client communication, and for sending healthcare reminders. Please indicate which contact would like to receive these emails.

PATIENT DETAILS

ADDITIONAL PET

ADDITIONAL PET

ADDITIONAL PET

Consent & Policies

LEASH AND CARRIER POLICY:

AUTHORIZATION FOR MEDICAL TREATMENT