New Client Form

NEW CLIENT INFORMATION

Your Full Name

Address

Address 2

City

Country

State/Province

Postal Code

Email (for office use only)

Primary Phone

Is your primary phone cell or home?

Cell
Home

Secondary Phone

Secondary Name on Account

Emergency Contact (other than yourself) Name and Relationship

Patients Name

Breed

Spayed or Neutered

Yes No Not Sure

Color and Markings

Birthday

Sex

Female Male Not Sure

Is your pet on long-term medications

Yes No Not Sure

If your pet is on long-term medications, please list them below

Are there any chronic problems?

Yes No Not Sure

List any chronic problems

Is your pet allergic to any medications or vaccines

Yes No Not Sure

Is your pet aggressive, or do they have a bite history?

If your pet is your pet allergic to any medications or vaccines please list them

Do we have your permission to post pictures or videos of your pet on our social media?

Yes No

Preferred means of contact

Text Email Phone

Please review the information above before continuing

I agree that, in the event of default on payments due, I agree to pay General Booth Veterinary Hospital all added costs of collection including, but not limited to 33 1/3% attorney fees.

How did you hear about us?

VA Vet Disclosure

This Vet Disclosure form is the second of three forms to be filled out before your first visit. Once you have completed this form please move on to the final part, the PreVisit Form, by clicking next. Our business and medical staffing hours are as follows: Monday 8:00 am - 6:00 pm Tuesday 8:00 am - 6:00 pm Wednesday 8:00 am - 6:00 pm Thursday 8:00 am - 6:00 pm Friday 8:00 am - 5:00 pm Saturday 8:00 am - 12 noon We are closed Sundays and holidays. This is to inform you that we have no in-house, on duty continuous medical staff care: Overnight from closing time to opening time at 8:00 am. Weekends from closing Saturday at 12 noon to opening time Monday morning at 8:00 am. Holidays from closing time the day before the holiday to opening time Monday morning at 8:00 am. Holidays falling on Monday from closing time on Saturday at 12 noon to opening time on Tuesday at 8:00 am. Animals hospitalized overnight are checked as needed through the night by the doctor and/or the technician. If continuous care is deemed necessary by the doctor, animals may be transported by the owner to the after-hours emergency hospital. Virginia State Code ÃÂ§ 54.1-3806.1. Any animal medical care facility in the Commonwealth, excluding those facilities dealing with livestock, as defined in ÃÂ§ 3.2-5900, which does not provide continuous medical care for all animals left in its charge shall, before taking charge of an animal, provide the client or agent thereof with a disclosure form which specifies the hours and days when continuous medical care is not available at the facility. Such form shall be separate and apart from any other form or information provided by the facility. Except in emergency situations when time or circumstances do not permit, such facilities may take charge of an animal only after the client or agent thereof has signed the disclosure form and returned it to the facility. Only one signed form per client shall be required, and the form shall be kept on file by the facility. 1991, c. 621; 1998, c. 158.

Please review the information above before continuing

I have read this form and am aware of the above staffing hours.

PreVisit Questionaire

Patients Full Name

Attach vaccine/medical records

Select File

:

Cancel

Age

Breed

Sex

Female Male Not Sure

Most Recent Weight

What problem is your pet experiencing?

When did the problem start?

Is the problem the same, better, or worse?

Same Better Worse N/A

Has a similar problem happened in the past?

Yes No Not Sure

Are any medications/supplements being administered? Please list

Heartworm and Flea & Tick Preventative?

What type of food do you feed your pet, including amount and frequency?

Is your pet on a grain-free diet?

Yes No Not Sure

Has your pet been vaccinated recently?

Yes No Not Sure

Has their eating changed?

Yes No

Any weight loss/gain?

Yes No Not Sure

Any increase or decrease in water consumption?

Yes No

Any changes in bowel movements?

Any exposure to toxins?

Any other medical history?

Additional Comments

Clients Initials

Late and No Show Appointment Policy

"Appointment Cancellations less than 24 hours" Policy 2023 If a client arrives more than 10 minutes late for their scheduled 30-minute appointment; and/or we have not been able to reach the client by phone, it is the DVM's discretion if they will need to reschedule their appointment. If the DVM elects to see the late appointment, the client needs to be aware that they will have to be worked into our typically full schedule. There may be a potential wait time of 1 hour or longer. If the client has to reschedule, then the client will be required to prepay a deposit for the exam fee in order to schedule a future appointment.

If a client is a "No Show" for their scheduled appointment, the client will have to prepay a deposit for the exam fee in order to schedule their next appointment.

Clients Initials

If an appointment is canceled within less than 24 hours by phone or via Pet Desk, a prepaid exam deposit will be needed to schedule the next appointment.

Clients Initials

Clients Full Name

Date

I have read and agree to the above

We would like to thank our clients for entrusting the doctors and staff of General Booth Veterinary Hospital with the care of their pets. We would like to bring attention to a few changes to our hospital policies. Please keep in mind that these changes are necessary for us to provide excellent client and patient care. The current state of veterinary medicine has been challenging. Urgent Care and 24-hour care facilities have seen an increase in their caseloads and a decrease in emergency veterinarians and support staff. These facilities have historically been crucial to assisting general practices with the overflow of emergency and urgent care cases. Medical cases that were typically managed by these urgent care facilities are now being turned away and referred back to the general practices to manage the patient's care. This increases the caseload of the general practice that oftentimes are operating at patient capacity. General practices are typically scheduling routine preventative care and non-urgent appointments 2-4 weeks from the initial appointment request. For this reason, we must operate efficiently in order to provide our clients and patients with the best possible veterinary medical care. For these reasons, we have instituted a Late and No Show Appointment Policy as well as a Cancellation Policy.

Client Information

NEW CLIENT INFORMATION

VA Vet Disclosure

PreVisit Questionaire

Late and No Show Appointment Policy