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- Feline Care Guide
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Welcome
About Our Practice
Our Services
Our Staff
Online Forms
Care Guides
- Canine Care Guide
- Feline Care Guide
Contact
Employment Opportunities

New Client Information

New Clients with scheduled appointments at Brandt Vet Services should bring with them any previous veterinary records, including but not limited to, most recent history of vaccinations and heartworm testing, as well as a fresh stool sample.

New Clients without an appointment currently scheduled at Brandt Vet Services should contact our office at 804-739-7892 at their earliest convenience to speak with a receptionist about scheduling an appointment. Please be advised that our schedule for routine wellness exams and preventative care books up approximately 2-3 weeks in advance.

We ask that all New Clients please arrive approximately 10 minutes early to their initial appointment to go through any paperwork necessary to establish their chart.

Client Information

First Name:

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Last Name:

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Street Address:

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City:

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State:

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Zip Code:

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Home Phone #:

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Cell Phone #:

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Work Phone #:

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Email Address:

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Driver's License #:

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Employer:

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Spouse/Partner/Other Name:

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Spouse/Partner/Other Phone #:

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If you had your preference in communicating with our clinic (you can select TWO) how would you like us to communicate with you:

Text Message

Telephone

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Additional Information

Preferred Method of Payment
(Professional Fees Are Due At The Time Services Are Rendered):

Cash

Check

Credit Card (Visa, MasterCard, or Discover accepted)

Debit

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Who May We Thank For Your Referral:

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Name of Previous/Current Veterinarian:

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Previous/Current Veterinarian Phone #:

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Vaccination Status & Payment Information

DUE TO STATE LAW AND INSURANCE REQUIREMENTS, ALL DOGS & CATS MUST BE CURRENT ON RABIES VACCINATION.

Vaccinations can be updated at the time of your appointment if it is not current. To help prevent the spread of infectious diseases, hospitalized and boarded animals must be current on all vaccinations. I understand every effort will be made to achieve a successful outcome and to provide for all possible safety in hospital care and handling. I hereby authorize this hospital to receive, prescribe for, treat or perform surgery upon the pet(s) listed below and additional pets I present. Furthermore, I agree to pay fees for services rendered at the time the pet is discharged from the hospital or the service is otherwise terminated. I agree to pay for the reasonable costs of collection in the event that collection efforts become necessary. I understand that a service fee of $20.00 will be assessed for each non-sufficient fund check.

Pet One

Pet's Name:

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Breed:

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Age or Date of Birth (approximate if unknown):

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Color/Markings:

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Sex:

Male

Female

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Spayed or Neutered:

Yes

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Indoor or Outdoor:

Indoor

Outdoor

Indoor/Outdoor

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Pet Two

Pet's Name:

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Breed:

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Age or Date of Birth (approximate if unknown):

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Color/Markings:

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Sex:

Male

Female

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Spayed or Neutered:

Yes

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Indoor or Outdoor:

Indoor

Outdoor

Indoor/Outdoor

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Pet Three

Pet's Name:

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Breed:

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Age or Date of Birth (approximate if unknown):

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Color/Markings:

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Sex:

Male

Female

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Spayed or Neutered:

Yes

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Indoor or Outdoor:

Indoor

Outdoor

Indoor/Outdoor

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Pet Four

Pet's Name:

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Breed:

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Age or Date of Birth (approximate if unknown):

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Color/Markings:

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Sex:

Male

Female

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Spayed or Neutered:

Yes

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Indoor or Outdoor:

Indoor

Outdoor

Indoor/Outdoor

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Yes, I understand and accept the policies listed above.

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Please enter your full name in the textbox below to accept the above policies.(*)

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Confirmation of Electronic Signing(*)

I understand that by typing my name above and clicking on "Submit", I am electronically signing this document.

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Today's Date:

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Downloaded?

Yes

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