New patient/New client Form

Name(Required)

First Last

Phone(Required)

Email(Required)

Pet's Name(Required)

Species

Dog

Cat

Breed

Color

Age / Date of Birth

Sex

Male

Male (neutered)

Female

Female (spayed)

When did you get your pet?

Where did you get your pet?

Shelter

Breeder

Pet Store

Online

Friend

Other

Please Specify

What kind of food do you feed your pet?

How much do you feed?

Free Fed (food is offered always/whenever hungry)

Measured Amount

Please specify how often and how much

Are there any concerns for the following: (check all that apply)

Sneezing

Coughing

Vomiting

Diarrhea

Eating

Drinking

Other

Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure?

Yes

If yes, please specify

Is your pet on any medications?

Yes

If Yes, please specify

Microchip:

There is an additional fee for this

Yes

Already has one

Nail Trim:

There is an additional fee for this

Yes

Do you need heartworm or flea prevention:

There is an additional fee for this

Yes

If Yes, please specify

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.

Yes, please perform CPR on my pet.

No, do not perform CPR on my pet.

PAYMENT(Required)

Photo ID required for all credit card, debit card, Care Credit and Scratchpay transactions. The photo ID must match the name on the card. All credit card, debit card, Care Credit and Scratchpay holders must be physically present to run the card and sign the transaction in person.

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

APPOINTMENTS:(Required)

To ensure your appointment is as timely as possible, we strongly recommend that the pet parent (responsible party) attend or bring the pet to the exam with the Veterinarian. A cancelation fee deposit of $65, will be collected when scheduling your pet’s next exam if you cancel, reschedule or miss the appointment in less than 24 hours. When appointments are not kept or canceled in a timely fashion, it prevents us from scheduling patients that need medical attention. The deposit will be applied towards your pet's exam fees at the time of discharge. If you're unable to cancel the appointment with a 24-hour notice, the deposit will be forfeited. We offer appointments 6 days a week, including 9am – 3:30pm on Saturdays - please take advantage of our extended hours to make sure you are available for your pet's exam.

I understand

VACCINE NOTIFICATION & DISCLOSURE:(Required)

Vaccines are administered to your pet to produce antibodies (to build up their immunity) against certain diseases. These vaccines are an important part of your pet’s well-being and protection. It is critical during their first few months to get this done as quickly and consistently as possible. Puppies & kittens do require vaccines to be boosted every 3-4 weeks during their first few months. Our staff will be providing you with our recommended vaccines, tests and preventatives. If your pet has passed the puppy/kitten stage they will still require their vaccines to be updated. Any time a new vaccine is introduced to your pet's immune system it will need to be boosted in a 3-4-week time frame. Please keep that in mind so your pet can be as protected as possible.

I understand

WELLNESS EXAMS:(Required)

If you are requesting that we vaccinate your pet, please be advised by state law, we can only vaccinate pets healthy enough to receive a vaccine. To determine if they are healthy, we require a physical exam performed by our Veterinarian to ensure we are only vaccinating healthy pets. If we administer vaccines you will be charged for a Wellness Exam ($65.00 plus vaccine costs) annually as well as any needed tests. If one of our Doctors has examined your pet over 30 days ago we will require another exam, to ensure your pet is healthy enough to receive a vaccine. Other fees will apply for pets that are sick or Injured as well as for Work-In Appointments or Emergencies.

I understand

I give True Companion Veterinary Care authorization to treat as discussed above.(Required)

I authorize

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*

Yes

If Curbside care is elected:(Required)

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.

Cancellation Policy:(Required)

I understand that appointment cancellations less than 24 hours before appointment and/or no shows will incur a $30.00 cancellation fee.

Please type your initials.

Date

MM slash DD slash YYYY

Please text photos of your pet's records to 832-930-7717 and/or email records to Hospital@truecompanionvetcare.com so that your veterinarian knows which vaccines or treatments have already been started. We need records before your appointment.

Signature

Name

This field is for validation purposes and should be left unchanged.