Fetch the Vet New Patient Form - Buffalo, NY Mobile Vet

URL

This field is for validation purposes and should be left unchanged.

Personal Information

Your Name*

First Last

Spouse/Co-Owner's Name

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Work Phone

Spouse/Co-Owner's Phone

Place of Employment

Best Time to Reach You*

Email*

Please indicate choice of payment:*

Cash/check
Visa
MasterCard
Discover

How did you hear about us?*

Drove by
Social media
Website
Client
Other

Name of previous veterinarian:*

Personal recommendation (whom may we thank?)

Pet Information

Are you registering cat(s) or dog(s)?*

Cats
Dogs
Both
Neither

List of Pets*

Fill in each column with your pet's information. If you have multiple pets that will be seeing us, please click the plus icon to add an additional pet.

Name	Breed	Date of Birth	Color	Sex	Spayed or Neutered?

Dog Vaccination History

List of Vaccines - Dog

Fill in each column with your dog's name and the dates they received each vaccination. If you have multiple dogs that will be seeing us, please click the plus icon to add another.

Dog Name	Date - Rabies	Date - DHLP PARVO	Date - BORDETELLA	Date - LYME	Date - LEPTOSPIROSIS	Date - FECAL (STOOL SAMPLE)	Date - HEARTWORM TEST

Cat Vaccination History

List of Vaccines - Cat

Fill in each column with your cat's name and the dates they received each vaccination. If you have multiple cats that will be seeing us, please click the plus icon to add another.

Cat Name	Date - Rabies	Date - FVRCP	Date - LEUKEMIA	Date - LEUKEMIA/Feline AIDS	Date - FECAL (STOOL SAMPLE)

Other Questions

Our pet(s) are:*

Indoor only
Outdoor only
Equally indoor/outdoor
A child's pet

Any previous serious illness or surgeries?

Any allergies to vaccinations or medications?

Any special diets or medications?

We frequently use peanut butter and canned cheese as positive reinforcement tools during examinations - are there any allergies within your home that would mean we need to examine your pets without their use?

Yes
No

Would you like to be present during treatment to your pet?

Yes
No

Any other information you'd like to add?

e.g. Does your pet display fear during examinations or during certain procedures? Do they prefer to be examined on the floor?

Consent given for images and/or video of you and/or your pet(s) to be used on our website, social media pages, or promotional materials?

Yes
No

Consent given for Fetch the Vet Mobile Veterinary Practice LLC to use SMS text messaging to communicate with you regarding your pets healthcare needs. Examples could include scheduling an appointment, answering your questions regarding a medical concern, confirming a medication refill request or indicating that we will be arriving to your home shortly. Messages are never used for advertising or promotional purposes. Message frequency varies. Message and data rates may apply. If you choose at anytime that you no longer wish to receive SMS text messages please send a message stating 'STOP'. Should you need to request additional information on our policies at any time please send a message stating 'HELP'.*

Yes, I agree to receive text messages from Fetch the Vet Mobile Veterinary Practice LLC at the phone numbers listed above
No, I do not wish to receive text messages from Fetch the Vet Mobile Veterinary Practice LLC in respect to my pets healthcare needs.

See our privacy policy on our FAQ page on how we handle your information . We never share or sell your opt in information. Alternatively you can copy and paste this link into your web browser to access the privacy policy directly: https://app.termly.io/policy-viewer/policy.html?policyUUID=ad42ce8c-020b-4c54-9a16-caa9949c7b6f