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AVIAN / REPTILE / SMALL MAMMAL INTAKE FORM

Hello! We are so excited to finally get to meet you! As we prepare for your first visit, we want to ensure a fear free experience. Please take a moment to complete the pre-visit questionnaire and you may also enroll in one of our preventative care VIP Membership plans.   

Pets age at 7 times the rate we do, so twice-yearly physical exams are the cornerstone of staying healthy. Our VIP Membership plans are designed to keep your pets healthy in an affordable, convenient way. In addition to the benefits listed in the plan, our plans also include Telehealth available daily from 6 a.m. to 10 p.m. and texting is available 24/7. We are always there when you need us the most, even if it is after hours.

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AVIAN/REPTILE/SMALL MAMMAL INTAKE Form

Thank you for trusting PetVet365 to care for your pet. So that we may become better acquainted, please complete the following: 

OWNER INFORMATION

Preferred Communication
Permission to use pictures, history, or medical information about your patients in the media?
How did you hear about us?

PATIENT INFORMATION:

Sex

MEDICAL HISTORY & PRESENTING CONCERNS

DIET

What water supply do you provide?
How is water provided?

ENCLOSURE / ENVIRONMENT

Where is the enclosure located?
What decor and furnishings are present?

What percentage of time does your pet spend inside and outside of its enclosure?

Is the animal supervised when out of the enclosure (is somene present at all times when the pet is not in the enclosure?)
Does anyone in the household smoke or vape indoors?

Payment Policy: FULL PAYMENT IS EXPECTED UPON RENDERING OF SERVICE. Alternative payment plans must be discussed prior to the start of treatment. Deposits are required on major/surgical cases, trauma cases, and emergency work where hospitalization is required. There is a fee for all returned checks. Outstanding balances on accounts may result in account information being sent to a collection agency.

Thanks for submitting!

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