New ClientInformation Form

Welcome to Parrett Veterinary Clinic. Complete our new client information form to get started with your pet’s care.

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Welcome to theParrett Veterinary Clinic Family

Fill Out the Form

Client Information

All fields marked with * are required and must be filled.

Primary Owner *

First

Last

Primary Owner Email *

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Work Phone

Secondary Owner

First

Last

Secondary Owner Email

Secondary Owner Cell Phone

Secondary Owner Work Phone

We would love to know how you heard about us:

If you are a new client & were referred by a friend, relative, or other party, please let us know who they are so we can extend our appreciation:

Type of exam requested:

Is your pet a *

Pet's Name

Breed

Color(s)

Birthday (or approximate birthday)

Sex

Male
Neutered Male
Female
Spayed Female

Microchip #

Allergies?

Where & when was your pet’s last veterinary visit?

Are there any health concerns or specific issues you would like to discuss with the veterinarian during your visit? Please be specific regarding health concerns and any abnormal symptoms your pet may be experiencing.

Does your pet take monthly heartworm, flea, or tick prevention? If so, what kind do you use?

Does your pet take any other medications on a regular basis? If so, what are the medication name(s), size(s), & frequency given?

What kind(s) of dry food(s) do you feed & how much do you offer each day?

What kind(s) of canned food(s) do you feed & how much do you offer each day?

What kind(s) of treats or other foods do you offer & how many / much do you offer each day?

Are there any routine services you need done, such as nail trimming or ear cleaning while here?

Dog Information

Rabies Vaccination: Critical Vaccine - Current vaccine from a licensed veterinarian is required by law and for hospital stay. If the vaccine is not current through our clinic, proof of vaccination from the providing veterinarian will be required before your pet can be admitted to the hospital.

Distemper/Parvo/Leptospirosis Vaccination: Critical Vaccine - Current vaccine from a licensed veterinarian is required for any stay in our facility. If the vaccine is not current through our clinic, proof of vaccination from the providing veterinarian will be required before your pet can be admitted to the hospital.

Lyme Vaccination: Critical Vaccine - This core vaccine for all dogs in our area of the country, regardless of lifestyle, is critically important as the amount of ticks and prevalence of Lyme Disease in pets and humans continues to rapidly escalate.

Bordetella Vaccination: Recommended if you ever plan to board your dog, use grooming facilities, visit dog parks or other places where your dog may be in a community setting with other dogs. Unless your dog is boarding, this vaccine is not required while your pet is staying at Parrett Veterinary Clinic.

Canine Heartworm, Lyme Disease, Ehrlichiosis, & Anaplasmosis Screening: Recommended annually for every dog, this test checks for common infections from mosquitoes and ticks.

Intestinal Parasite Screening / Stool Sample Screening: Needed annually for every adult dog (twice for puppies) to test for intestinal parasites. Many of these parasites are zoonotic, meaning infection can be spread from pets to people, and can cause illness in both pets and humans. If you opt for this service, please be sure to bring a fresh sample with you at the time of your appointment.

Early Detection Screening: Bloodwork and urine screening is recommended on an annual basis. This becomes more critical as your pet ages. These screenings help us determine if there are any underlying abnormalities that can’t be detected on an outward physical exam.

Microchip: Should your pet ever go missing, permanent identification gives you the best chance of your pet being returned. Our clinic uses a Home Again microchip for your pet that is guaranteed not to migrate throughout the body after it is implanted, ensuring easy location when your pet is scanned. Additionally, when we implant your Home Again microchip, we pay for your microchip registration and enroll your pet immediately.

Comprehensive parasite prevention is critical in protecting your pet and family’s health. For dogs, this means giving them two key medications every 30 days. Sentinel Spectrum should be given all year round to prevent heartworm disease, flea infestation, and to deworm monthly for roundworm, hookworm, whipworm, and tapeworms. The clinic offers a discounted price on 6 packs and an additional discount on 12 packs. Virbac also offers progressive rebates on 6 and 12 packs, while supplies last.

In addition to Sentinel Spectrum, NexGard should be given every 30 days all year round to prevent tick infestation, Lyme disease, and minimize the risk of other infectious disease transmitted by ticks. The clinic offers a discounted price on 6 packs and an additional discount on 12 packs.

Cat Information

Feline Distemper Combo Vaccination: Critical Vaccine - Current vaccine from a licensed veterinarian is required for any stay in our facility. If the vaccine is not current through our clinic, proof of vaccination from the providing veterinarian will be required before your pet can be admitted to the hospital.

Feline Leukemia Vaccination: Recommended for all kittens or cats receiving their vaccine series for the first time in addition to any cat that might ever go outside. Cats who could be exposed to other non-vaccinated cats (ie: cats that come in from the outside or through screen windows or porches, families that might kind-heartedly rescue another stray that could get brought into the household) should also receive this vaccine.

Feline Leukemia, FIV, and Heartworm Screening: Recommended annually for every cat, this test checks for common infections transferred from mother to kitten, cat to cat, and from mosquitoes.

Intestinal Parasite Screening / Stool Sample Screening: Needed annually for every adult cat (twice for kittens) to test for intestinal parasites. Many of these parasites are zoonotic, meaning infection can be spread from pets to people, and can cause illness in both pets and humans. If you opt for this service, please be sure to bring a fresh sample with you at the time of your appointment.

Early Detection / SDMA Screening: Bloodwork and urine screening is recommended on an annual basis. This becomes more critical as your pet ages. These screenings help us determine if there are any underlying abnormalities that can’t be detected on an outward physical exam.

Comprehensive parasite prevention is critical in protecting your pet and family’s health. For cats, this means giving them key medication every 30 days. Nexgard combo for cats should be given all year round to prevent heartworm disease, flea and tick infestation, and to deworm monthly for roundworm and hookworm.

Clinic Policies

Medical Records Release: I, owner of aforementioned pet(s), do hereby consent to the release of any of my pets’ medical records to boarding or grooming facilities, animal shelters, veterinary practices, or law enforcement and can be released upon their request. I understand that this does not authorize Parrett Veterinary Clinic to release my records to any other third party such as a neighbor or the new owner of my pet. In the event a pet has gone to a new home, it is still my responsibility to contact Parrett Veterinary Clinic to give authorization to release that pet’s medical information. I understand that if my account is not in good standing with the clinic, records will not be released to any party aside from a law-enforcement of human health care agency (please select one):

Social Media Consent: Parrett Veterinary Clinic requests permission to take photographs & videos of me and/or my pet for the purpose of posting on Parrett Veterinary Clinic’s Facebook, Twitter, YouTube, & clinic website. Parrett Veterinary Clinic is released of any and all claims as a result of the use of any photos & videos. Therefore, Parrett Veterinary Clinic (please select one):

Text Message & Data Usage As text messaging becomes a more used & convenient way to stay in touch, many clients have expressed an interest in receiving wellness updates about their hospitalized pet in this format. Data usage fees from your carrier may apply. Please let us know if any of the following are an option for you (please select one):

Payment Policy: All professional fees are due when services are rendered.

We will gladly provide a written estimate of service fees if you desire. For your convenience we accept Cash, Check, Visa, Mastercard, Discover, American Express, and Care Credit. For Check and Care Credit payments, the account holder must be present and provide a valid form of identification (ex: Driver’s License, State ID, etc). For a balance outstanding, a statement handling fee of $1.00 per month will be added to any balance owed for greater than 30 days. In the event that the account is unpaid for a period of 90 days, it will incur additional collection fees and be submitted for prosecution.

Payment Policy: All professional fees are due when services are rendered We will gladly provide a written estimate of service fees if you desire. For your convenience we accept Cash, Check, Visa, Mastercard, Discover, American Express, and Care Credit. For Check and Care Credit payments, the account holder must be present and provide a valid form of identification (ex: Driver’s License, State ID, etc). For a balance outstanding, a statement handling fee of $1.00 per month will be added to any balance owed for greater than 30 days. In the event that the account is unpaid for a period of 90 days, it will incur additional collection fees and be submitted for prosecution.

I understand the payment policy terms of Parrett Veterinary Clinic and hereby agree to abide to their terms.

Have you been to our clinic before?

Estimate: Please let us know if you would like us to provide you with an estimate for your requested procedures.

First Choice for Appointment Date & Time:

Date

Time

Second Choice for Appointment Date & Time:

Date

Time

family’s vaccine. given?

Third Choice for Appointment Date & Time:

Date

Time

If you have provided us with an email and our practice has processed your information, you will have access to your pet records online. Please allow 1-5 business days upon completion of this form before trying to access your pet portal. You may then visit our website, find the Pet Portal link, and create a user password to go with your user ID (your email address). You may then view our appointment availability for every type of visit to request a time and day that works best for you.

Clinic Policies

Payment Policy: All professional fees are due when services are rendered.

Payment Policy: All professional fees are due when services are rendered. We will gladly provide a written estimate of service fees if you desire. For your convenience we accept Cash, Check, Visa, Mastercard, Discover, American Express, and Care Credit. For Check and Care Credit payments, the account holder must be present and provide a valid form of identification (ex: Driver’s License, State ID, etc). For a balance outstanding, a statement handling fee of $1.00 per month will be added to any balance owed for greater than 30 days. In the event that the account is unpaid for a period of 90 days, it will incur additional collection fees and be submitted for prosecution.

I understand the payment policy terms of Parrett Veterinary Clinic and hereby agree to abide to their terms.

Have you been to our clinic before?

Estimate: Please let us know if you would like us to provide you with an estimate for your requested procedures.

First Choice for Appointment Date & Time:

Date

Time

Second Choice for Appointment Date & Time:

Date

Time

Third Choice for Appointment Date & Time:

Date

Time

New ClientInformation Form

Welcome to theParrett Veterinary Clinic Family

Fill Out the Form

Client Information

Dog Information

Cat Information

Clinic Policies

Clinic Policies

Ready to Visit?

Have a Question?

Location

Contact Information

Appointment Hours

Reception Hours