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HOME
MEET THE VET
MOBILE VET SERVICES
STORY TAILERS
ONLINE PHARMACY
GALLERY
CONTACT
CLIENT/PET INFO FORM

NEW CLIENT / NEW PATIENT FORM

Contact Us

Name:

Address:

Phone:

Email:

Employer / Occupation:

Work Phone:

Emergency Contact:

Pet's Name:

Birthdate / Approx. Age

Sex:

Reproductive Status:

Species

Breed:

Color:

Primary / Previous Veterinarian

Previous Injuries, Illnesses, Surgeries, Diagnoses:

Current Medications:

Does Your Pet Have Any Fears or Anxieties?

No anxieties

Aversive to touch (face, ears, belly, feet, tail, etc)

Fearful of new people

Fearful of men

Does not like nail trims

Afraid of muzzles

Thunderstorm / Firework / Noise Phobia

How Does Your Pet Respond When Fearful or Anxious?

My Pet is not fearful/anxious

Bites

Scratches

Lunges

Tucks Tail

Hides / Runs Away

Hisses

Howls / Screams

Urinates / Defecates

Freezes / Shakes

Becomes Protective of Owner

Name of Current Pet Food:

Known Allergies:

Has Your Pet Experienced A Vaccine Reaction?

Date of Last Rabies Vaccine:

1 or 3 Year Rabies Vaccine?

Name of Current Heartworm Prevention:

Name of Current Flea & Tick Prevention:

Media Release Authorization: I authorize The Advetcate, LLC to use, reproduce, and/or publish photographs and/or video that may pertain to my pet — including my pet’s image, likeness and/or sound without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors. This material may also appear on The Advetcate’s Internet Web Page or its other social media sites. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, The Advetcate, LLC may publish materials, use my pets’ name, photograph, and/or make reference to my pet(s) in any manner that The Advetcate, LLC deems appropriate in order to promote/publicize/educate service opportunities.

Payment Terms Authorization: Our preferred methods of payment include: Debit and Credit cards (Visa, Mastercard, American Express, Discover). In signing this agreement, I assume full financial responsibility for all charges incurred for the care of my pet(s). I understand that payment for the entire medical plan is required when services are rendered, and if I fail to pay the entire amount at the time services are rendered, that I agree to pay any and all reasonable costs of collection in the event that collection efforts become necessary.

Client Agreement: I hereby authorize The Advetcate, LLC and all assistants of its choice to administer any medical and/or surgical procedures as is considered therapeutically and/or diagnostically necessary. I also hereby release The Advetcate, LLC and all its assistants, from any liability by any reason of any act herein above authorized. I understand every effort will be made to achieve a successful outcome and that The Advetcate, LLC and all of its assistants will perform all possible safety procedures while handling my pet(s).

Typing my legal name in the box below using any device, means or action, indicates that I agree my electronic signature is the legal equivalent of my manual/handwritten signature on this Agreement. I have read, understood, and accept the Payment Terms and Client Agreement listed above. I am also consenting to the legally binding terms and conditions of this agreement, and agree that I the owner or responsible party of the pet listed on this form.

Typing my legal name in the box below using any device, means or action, indicates that I agree my electronic signature is the legal equivalent of my manual/handwritten signature on this Agreement. I have read, understood, and accept the Payment Terms and Client Agreement listed above. I am also consenting to the legally binding terms and conditions of this agreement, and agree that I the owner or responsible party of the pet listed on this form.

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Quick Link

HOME
MEET THE VET
MOBILE VET SERVICES
STORY TAILERS
ONLINE PHARMACY
GALLERY
CONTACT
CLIENT/PET INFO FORM

HOME
MEET THE VET
MOBILE VET SERVICES
STORY TAILERS
ONLINE PHARMACY
GALLERY
CONTACT
CLIENT/PET INFO FORM

Contact Information

Phone:

Email:

theadvetcatescheduling@gmail.com

Address: Louisville, KY

Visa Payment Accepted

MasterCard Payment Accepted

American Express Payment Accepted

Discover Payment Accepted

Check Payment Accepted

Visa Payment Accepted

MasterCard Payment Accepted

American Express Payment Accepted

Discover Payment Accepted

Check Payment Accepted

Business Hours

Monday 8:00am - 2:00pm

Tuesday Closed

Wednesday 8:00am - 5:00pm

Thursday 8:00am - 5:00pm

Friday 8:00am - 5:00pm

Saturday 8:00am - 2:00pm

Sunday Closed

Monday 8:00am - 2:00pm

Tuesday Closed

Wednesday 8:00am - 5:00pm

Thursday 8:00am - 5:00pm

Friday 8:00am - 5:00pm

Saturday 8:00am - 2:00pm

Sunday Closed

Request An Appointment

Content, including images, displayed on this website is protected by copyright laws. Downloading, republication, retransmission or reproduction of content on this website is strictly prohibited. Terms of Use | Privacy Policy

Content, including images, displayed on this website is protected by copyright laws. Downloading, republication, retransmission or reproduction of content on this website is strictly prohibited. Terms of Use | Privacy Policy

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