Tech Appointment Form

Thank you for entrusting your pet’s care to us today! The following information will be used to help our veterinary team accurately complete your pet’s medical history for today’s technician visit. We will need to be able to contact you or someone with permission to make medical and financial decisions.

Name(Required)
Who should we contact to make medical decisions today?
Sex
Are there any concerns for the following: (check all that apply)
Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure?
Is your pet on any medications?
This includes heartworm/flea prevention, over the counter and prescription
Microchip
There is an additional fee for this
Nail Trim:
There is an additional fee for this
Anal gland expression:
There is an additional fee for this
Do you need any of the following for Flea/Tick/HW prevention:
CPR PERMISSION(Required)
I understand Your Veterinary Practice- 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 Your Veterinary Practice 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. 
Financial Responsibilities(Required)
Authorization to Treat(Required)
PAYMENT:(Required)
APPOINTMENTS:(Required)
VACCINE NOTIFICATION & DISCLOSURE:(Required)
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 Your Veterinary Practice 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*
If Curbside care is elected:(Required)
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If we do not already have records: Please text photos of your pet's records to 832-930- 7717 and/or email records to info@YourVetPractice.com so that your veterinarian knows which vaccines or treatments have already been started. We need records before your appointment.
Have you or anyone that you have had close contact with tested positive for COVID-19 in the past 14 days?
Have you or anyone in your house experienced the following symptoms in the past 14 days?
Who experienced these symptoms?

*If you are ill or have been exposed to someone who is ill, we request that a family member or friend bring your pet to their appointment*

Cancellation Policy:(Required)
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.