New Client Form in Ferndale, MI | Little Friends of Ferndale Veterinary Care

Welcome to Little Friends of Ferndale. Thank you for giving us the opportunity to care for your pet. Please help us to support your animal family’s needs by sharing some information with us. Acct.#

Client Information

Date

Owner’s Name:*

Primary Phone:*

Address*

Street Address City ZIP / Postal Code

Co-Owner/Spouse

Co-Owner/Spouse Phone:

Employer:

Work Phone:

Email Address :*

Who referred you to LFOF?

In case of an emergency involving your pet, and we are unable to contact you, who would you like us to contact?

Name:*

Phone*

Previous veterinary hospital that took care of your pet(s)?

Please note that full payment is due at the time services are rendered. We will gladly prepare a written estimate for your visit – just ask a receptionist. We accept cash, Visa, Discover or Mastercard (debit or credit). We do not accept personal checks.

Signature of Owner/Authorized Agent

Patient Information

Pet’s Name:*

Date of Birth/Age*

Species (Dog/Cat)*

Breed*

Color*

Gender*

Male
Female

Spayed/Neutered*

Yes
No

Microchipped*

Yes
No

On Heartworm Preventative? What kind?*

Yes
No

what kind*

On Flea/Tick Preventative? What kind?*

Yes
No

what kind*

Will dog go to kennel, groomer, dog park, or training class?*

Yes
No

Does cat go outside?*

Yes
No

Any known allergies? Or adverse reactions to vaccines/medications?*

Any previous serious illness/surgeries?*

Authorization release of information for Media or Website Publication

I authorize Little Friends of Ferndale Veterinary Care and its agents to take photos of my pet or pet’s condition and copyright, use and publish the same in print and/or electronically. I agree that Little Friends of Ferndale Veterinary Care may use such photographs or my pet with or without my name and for the lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

Untitled

I have read and agree the above statement.

Pre-Visit Questionnaire

At Little Friends of Ferndale, we want to make your visit to our hospital the best it can be for both you and your pet. Please take a few minutes to answer the following questions so we can take both your and your pet's preferences for your visit into consideration.

1. How would you describe your pet's reaction to going to the veterinary hospital?*

Eager and excited
Subdued
Reluctant
Somewhere in between

2. Are there things you or your pet did NOT like during past veterinary visits?*

Being weighed
Getting onto the exam table
Having a procedure done
Being handled by the veterinary staff
Walking through the clinic
Other

Please describe

3. How would you describe your pet around other animals and people, such as in the lobby area of the veterinary hospital?*

4. Is your pet currently on any anti-anxiety medications or pre-visit medication?*

Yes
No

if yes - please list medication and dosing information

5. What are you pet's favorite treats? (please bring some to the visit)*

6. Are there any food restrictions or allergies?*

7. Does your pet like to play with toys? if so, what kinds? (feel free to bring your pet's favorite toy)*

A successful visit starts at home and continues during your travel to our hospital. To help you provide your pet with a pleasant experience on the way to the hospital, we can send you some preparation tips via emai. Or you can check out Fearfreehappyhomes.com for more tips. However, we have a few questions regarding travel to see if we can make any special recommendations.

8. How and where does your pet travel in the car?*

Carrier
Seat belt
Loose

9. Does your pet show any reluctance getting into the carrier or car?*

Yes
No

10. Is assistance needed getting your pet into or out of the vehicle? Any special requirements (ramp, stairs, etc.)*

Yes
No

11. How does your pet behave in the car?*

Yes
No

12. Any nausea, drooling, or vomiting with car travel?*

Yes
No

13. Has your pet needed medication in the past for travel?*

Yes
No

if yes - please list medication and dosing information

Please understand that your pet's well being is of utmost importance to us. Our goal is to provide you and your pet a safe and stress-free environment.

Signature*

Owner's Name*

Pet's Name*

Date*

Printed name

Please note: A $85.40 deposit is required to confirm your booking. This deposit is non-refundable and will be applied to your balance on the day of service.

New Client Form

Client Information

Patient Information

Pre-Visit Questionnaire

Accessibility Tools