Client Information Form

Brooklyn Yard Veterinary Hospital Client Information Form
Please review our lobby protocol:
- We are welcoming clients for in-clinic exams. However, our check-in process is a little different due to considerations for our more sensitive patients and to help keep the stress levels down in general, for both people and animals.
  - Curbside check-in by phone is to remain indefinitely.
    This is due to the nature of our patient population, as it allows us to control traffic in and out of the clinic and keep the stress level down for our patients.
  - Because of this, we keep our front door locked at all times and ask that you always call us when you arrive, even if you are only here to pick up medication or drop off a sample.
- When checking in for an appointment, please remain in your car and do not wait outside the front door with your pet. It is important to provide all our patients with as much space as possible.
- Further instructions for check-in and visit communication are included in all of our pre-appointment emails!
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*

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CLIENT DETAILS
Primary Contact*

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

PhoneTextEmail
Secondary Contact

First NameLast Name
Pronouns
*Not required, share if you'd like to!
Phone Number
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 ContactPhone call
We utilize e-mail as our primary method of sending health care reminders. Please indicate which contact would like to receive these reminders.
Please Email:*

Primary ContactSecondary ContactBoth
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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!

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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!
LEASH AND CARRIER PROTOCOL

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:*
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 while in the custody of the hospital.

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 check off all policies after reading*
Please sign here to acknowledge you accept our outlined policies*

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Do you have medical records for your pet?*
Please upload any files or pertinent medical records

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Brooklyn Yard Veterinary Hospital Client Information Form

CLIENT DETAILS

PATIENT DETAILS

ADDITIONAL PET

ADDITIONAL PET

ADDITIONAL PET

Consent & Policies