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9818 Fry Rd Ste 180. Cypress, TX 77433
832-930-7717
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Home
COVID-19
About Us
Services
Schedule Appointment
Emergency Care
Refer a Friend
Testimonials
Forms
Scheduling / New Client Registration Fee
Hospitalization Form
Medical Boarding Form
New patient/New client Form
Emergency Exam Form
Medical Concern Form
Annual Exam Form
Tech Appointment Form
Medical Progress Exam Form
Anesthesia/Surgical Consent Form
Join Our Team
Contact Us
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
Select All
Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure?
Yes
No
If yes, please specify
Is your pet on any medications?
Yes
No
If Yes, please specify
Microchip:
There is an additional fee for this
Yes
No
Already has one
Nail Trim:
There is an additional fee for this
Yes
No
Do you need heartworm or flea prevention:
There is an additional fee for this
Yes
No
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 $54, 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 ($54.00 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
No
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
Comments
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