Who should we contact to make medical decisions today? If you have any questions, please contact our team members prior to your arrival for assistance. (Required) Reason for visit: (check all that apply) What symptoms has your pet been experiencing? Are there any concerns for the following: (check all that apply) When did the problem start? Have the symptoms worsened, improved, or stayed the same since you first noticed them? Does your pet have a history of seizures? Has your pet experienced this problem in the past? Is your pet on any medications?
This includes heartworm/flea prevention, over the counter and prescription
Has your pet had any surgeries in the past? How much do you feed? Have there been any changes in appetite? Any increase or decrease in water consumption? Any change in bowel movements? Does your pet spend time outside, even for walks or in the yard? Does your pet come into contact with other dogs?
Please check all that apply
Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure? Is your pet current on vaccines? Do you have a copy of your pets most recent Rabies certificate?
If Yes, please specify the clinics name and email certificate to
Do you have a regular veterinarian that your pet sees? CPR Permission (Required)
I understand True Companion Veterinary Care, PLLC (TCVC) requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of TCVC, PLLC will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400. I understand that there is no guarantee of successful resuscitation.
Once you arrive for the emergency, we require the $105.00 exam fee to be collected upfront. (Required) I have read and understand Financial Responsability (Required)
Once the doctor has completed your pet’s exam, we will contact you to go over the recommended treatment plan. I understand that financial responsibilities for services are rendered when the treatment plan is approved..
I have read and understand Emergency Procedures (Required)
By agreeing to such emergency procedure, I am aware that I will be held responsible for all services provided to my pet. I also understand that despite the best effort of the doctor and staff at this facility, even the most successful CPR that may restore my pet's life, may not allow my pet to regain normal mental or physical health.
I have read and understand PAYMENT: (Required)
Payment in full is required at the end of your visit today. Once your pet’s exam is completed, we will contact you to go over the exam findings and recommendations. We accept Visa, Mastercard, American Express, Discover, CareCredit and Scratchpay for payment. Should you opt for CareCredit or Scratchpay as your form of payment, we ask that you apply prior to your visit to streamline your appointment. We do not accept checks and strongly discourage the use of cash due to the global pandemic.
I understand. Social Media/Photo Permission
Do we have your permission to post photos of your pet online? Your pets' picture or video may be taken while they are with us and used for True Companion Veterinary Care advertisement (www.truecompanionvetcare.com) or other social media purposes (Facebook, SnapChat, Instagram, etc.). Please indicate if you authorize for their pictures/videos to be posted or used. * If you do not authorize for your pet’s picture to be included in our marketing materials/venues, we may still use a picture of your pet in our patient records for our internal identification only*
I give True Companion Veterinary Care authorization to treat as discussed above. (Required) I have read and agree. If Curbside care is elected: (Required)
If Curbside care is elected: During the duration of the exam, your pet will be in the care of one of our team members. A team member will collect your pet from outside the building and support them through the exam, any services required, and then bring them back to your vehicle, when your pet is ready to go home. We strongly recommend you head home and a veterinarian or nurse will call you to discuss your pet’s exam and discuss recommended treatments, preventative measures and give an estimated discharge time.
I have read and understand. Have you or anyone that you have had close contact with tested positive for COVID-19 in the past 14 days? Have you or anyone in your house experienced the following symptoms in the past 14 days? Who experienced these symptoms? If you are ill or have been exposed to someone who is ill, we request that a family member or friend bring your pet to their appointment Cancellation Policy: (Required) Signature
Signature locked. Reset to sign again