Forms Test - Blue Oaks Veterinary Clinic, Willow Rock Pet Hospital

I,

, the legal owner and guardian of

understand that the Active Adult Wellness Package includes the following items:

Rabies Vaccine
Distemper Parvo Vaccine
Leptospirosis Vaccine
CIV Vaccine
Bordetella Vaccine
Lyme Vaccine
Rattlesnake Vaccine
(2) Pyrantel Dewormings
(1) Fecal Test
Annual Heartworm Test
Annual Blood work (SuperChem/Lytes/CBC/UA/T4) with Cystocentesis
- Which includes full blood panel, urinalysis, and thyroid test
Unlimited exams/office calls for one year
10% Discount on annual Dental Prophylaxis and Dental Radiographs
10% Discount on biannual Proheart injection for heartworm prevention
10% Discount on Bravecto flea and tick medication
All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.

Furthermore, I understand the following conditions of purchase of this package:

I can purchase the package up to seven days after this pet's first visit to have the covered services credited toward the purchase of the package.
This package is non-transferable between pets, but can be transferred to a new owner of the pet listed.
The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
The 10% discount on dental prophylaxis and dental radiographs (1) does not include blood work, medications to go home, or extractions and (2) only applies if the full dental package is purchased (pre-anesthetic panel, dental prophylaxis, and full mouth preventative dental radiographs).
If I fail to bring my pet in for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) that may be required.
The Active Adult Wellness Package is valid for one year from date of purchase, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.

Please sign here:
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I,

, the legal owner and guardian of

understand that the Active Puppy Wellness Package includes the following items:

Rabies Vaccine
Distemper Parvo Vaccine
Leptospirosis Vaccine
CIV Vaccine
Bordetella Vaccine
Lyme Vaccine
Rattlesnake Vaccine
(2) Pyrantel Dewormings
(2) Fecal Tests
Heartworm Test
Unlimited exams/office calls until one year of age
20% Discount on the cost of the Spay/Neuter
All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.

Furthermore, I understand the following conditions of purchase of this package in relation to the patient listed above:

I can purchase the package up to seven days after their first visit to have the covered services credited toward the purchase of the package.
This package is non-transferable between pets, but can be transferred to a new owner.
The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
The 20% discount on spay/neuter (1) does not include blood work or medications to go home and (2) must be completed before he/she turns one year old.
If I fail to bring him/her for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) he/she may require.
The Active Puppy Wellness Package is valid until he/she turns one year old, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.
This package does not include any items that are not listed above. Items not included in the package are additional tests, medications, nail trims, anal gland expressions, or preventative care such as heartworm or flea prevention that may be recommended by the veterinarian for your pet.

Please sign here:
[uacf7_signature* uacf7_signature-831]

I,

, the legal owner and guardian of

understand that the Adult Feline Wellness Package includes the following items:

Rabies Vaccine
Feline Distemper Vaccine
Feline Leukemia Vaccine
(2) Pyrantel Dewormings
(1) Fecal Test
Annual Feline Triple Snap Test (FeLV, FIV, Feline HW)
Annual Blood work (SuperChem/Lytes/CBC/UA/T4) with Cystocentesis
- Which includes full blood panel, urinalysis, and thyroid test
Unlimited exams/office calls for one year
10% Discount on annual Dental Prophylaxis and Dental Radiographs
10% Discount on Bravecto flea and tick medication
All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.

Furthermore, I understand the following conditions of purchase of this package:

I can purchase the package up to seven days after my pet’s first visit to have the covered services credited toward the purchase of the package.
This package is non-transferable between pets, but can be transferred to a new owner of the pet listed.
The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
The 10% discount on dental prophylaxis and dental radiographs (1) does not include blood work, medications to go home, or extractions and (2) only applies if the full dental package is purchased (pre-anesthetic panel, dental prophylaxis, and full mouth preventative dental radiographs).
If I fail to bring my pet in for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) they may require.
The Adult Feline Wellness Package is valid for one year from date of purchase, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.

Please sign here:
[uacf7_signature* uacf7_signature-831]

I,

, the legal owner and guardian of

understand that the Adult Wellness Package includes the following items:

Rabies Vaccine
Distemper Parvo Vaccine
Leptospirosis Vaccine
CIV Vaccine
Bordetella Vaccine
(2) Pyrantel Dewormings
(1) Fecal Test
Annual Heartworm Test
Annual Blood work (SuperChem/Lytes/CBC/UA/T4) with Cystocentesis
- Which includes full blood panel, urinalysis, and thyroid test
Unlimited exams/office calls for one year
10% Discount on annual Dental Prophylaxis and Dental Radiographs
10% Discount on biannual Proheart injection for heartworm prevention
10% Discount on Bravecto flea and tick prevention
All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.

Furthermore, I understand the following conditions of purchase of this package:

I can purchase the package up to seven days after this pet’s first visit to have the covered services credited toward the purchase of the package.
This package is non-transferable between pets, but can be transferred to a new owner of the patient listed.
The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
The 10% discount on dental prophylaxis and dental radiographs (1) does not include blood work, medications to go home, or extractions and (2) only applies if the dental package is purchased (pre-anesthetic panel, dental prophylaxis, and full mouth preventative dental radiographs).
If I fail to bring my pet in for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) they may require.
The Adult Wellness Package is valid for one year from date of purchase, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.

Please sign here:
[uacf7_signature* uacf7_signature-831]

Date of Birth:

I hereby certify that I am the legal and rightful owner of the pet mentioned above.
I authorize the veterinary clinic and all veterinarians, agents, staff, and representatives therein to euthanize and dispose of said animal.
I release and hold harmless all agents, staff, and representatives from any liabilities that may arise from the euthanasia and disposal.
I further swear and verify that the aforementioned animal has not scratched or bitten anyone in the last ten (10) days. If the animal has scratched or bitten anyone in the last ten days, the animal is required to have a rabies test before euthanasia takes place.
I understand that the euthanasia process is used to painlessly put down animals.
What needs to happen with the remains?
Release remains to the veterinary clinic and I WOULD like the cremated remains returned to me, and opt for private cremation.Release remains to the veterinary clinic and I WOULD NOT like the cremated remains to me, and opt for communal cremation.
I hereby accept full and total responsibility for the remains after the procedure. I have read up on all applicable laws concerning disposal of remains. I understand the laws and the inherent dangers of disposing of animals.
Please sign here:
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Date or Birth:

Sex
MaleFemale

Neutered
YesNo

Appetite
NormalIncreasedDecreased

Weight
NormalIncreasedDecreased

Water Intake
NormalIncreasedDecreased

Urination
NormalIncreasedDecreased

Bowel Habits
NormalIncreasedDecreased

Exercise
NormalIncreasedDecreased

Vomiting
NoneDailyWeeklyIntermittent

Diarrhea
NoneDailyWeeklyIntermittent

Sneezing
NoneDailyWeeklyIntermittent

Coughing
NoneDailyWeeklyIntermittent

Start Date of Cough:

Cough Change
WorsenedImprovedStayed the Same

Cough Time
At nightIn the morningAfter activity/ExcitementAfter DrinkingAnytime

Cough Character
HarshHonkingWheezingSoftWetEnds with gag

Cough Impact
YesNo

Cough Treatment
YesNo

Breathing Difficulty
NoneDailyWeeklyIntermittent

Difficulty Breathing Time
With ExcitementActivity/exerciseRest/SleepAfter coughOther

Breathing Comfort
YesNo

Fainting/Collapse
NoneDailyWeeklyIntermittent

Dates of Events:

Fainting Occurrence
ExcitementActivity/exerciseRest/SleepAfter coughOther

Fainting Symptoms
LimpStiffTrembling/ShakingPaddlingGum chewingUnconsciousConsciousUrinatedDefecated

Diet
CannedDryBoth

Heartworm Prevention
YesNo

Heartworm Prevention Frequency
Every monthMost monthsRarely

I,

, the legal owner and guardian of

understand that the Kitten Wellness Package includes the following items:

Rabies Vaccine
Feline Distemper Vaccines
Feline Leukemia Vaccines
(2) Pyrantel Dewormings
(1) Fecal Test
Feline Triple Snap Test (for FIV, FeLV, and Feline HW)
Unlimited exams/office calls until one year of age
20% Discount on the cost of the Spay/Neuter
All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.

Furthermore, I understand the following conditions of purchase of this package in relation to the patient named above:

I can purchase the package up to seven days after their first visit to have the covered services credited toward the purchase of the package.
This package is non-transferable between pets, but can be transferred to a new owner.
The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
The 20% discount on spay/neuter (1) does not include blood work or medications to go home and (2) must be completed before he/she turns one year old.
If I fail to bring him/her for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) he/she may require.
The Kitten Wellness Package is valid until he/she turns one year old, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.

Please sign here:
[uacf7_signature* uacf7_signature-831]

Welcome to our veterinary clinic! Please complete the following form to register as a new client.

Permission to collect previous vet records?

Please read and acknowledge our clinic policies:

Client Partnership Guidelines and Commitments

Please accept each section after reading to confirm your understanding and agreement. If you have any questions or concerns, feel free to reach out to our management team for a friendly discussion.

Mutual Respect Policy: At Blue Oaks Veterinary Clinic and Willow Rock Pet Hospital, we are committed to treating our clients with the highest respect and kindness. We kindly ask for the same courtesy in return. For any concerns or issues, please directly contact our management team. You can email our practice manager, Lisa Miller, at lisa.miller@blueoaksvet.com or lisa.miller@willowrockpet.com. Please note that aggressive behavior such as yelling, cursing, or threatening will result in termination of our services.

Payment Policy: We kindly request that all payments be made at the time of service. We accept cash, major credit cards, and CareCredit. Please note personal checks are not accepted.

Social Media Consent: We often find your pets irresistibly adorable and may wish to capture their moments for our social media and marketing. Do we have your permission to use your pet's photos, with only their names shared publicly?

Rabies Vaccination Requirement: For the safety of all, we require up-to-date Rabies vaccinations for all cats and dogs visiting our facilities. Proof of vaccination is needed before your first appointment, or a Rabies vaccine will be administered (subject to doctor's discretion for unwell pets).

Spay and Neuter Identification: All cats and dogs spayed or neutered at our clinics will receive a small green line tattoo near the surgical incision. This is a universal indicator of the procedure.

Feedback and Online Reviews: We value direct communication and kindly ask that any service or care concerns be discussed with our owners or practice manager before public online feedback. Leaving negative reviews without prior internal resolution will lead to discontinuation of our services, as it affects the trust and relationship we strive to maintain.

Appointment Cancellation Policy: If you need to cancel or reschedule, please provide at least 24 hours' notice. Insufficient notice will require a non-refundable deposit equal to the exam cost for future appointments. This deposit will be forfeited without a 24-hour notice for cancellations or rescheduling.

I hereby confirm that all the information provided is accurate and true to the best of my knowledge. I have read, understood, and agree to adhere to all the clinic policies as outlined in the Client Partnership Guidelines and Commitments. By initialing each section and signing below, I acknowledge my understanding and acceptance of these terms and policies.

Please sign here:
[uacf7_signature* uacf7_signature-831]

I,

, the legal owner and guardian of

understand that the Puppy Wellness Package includes the following items:

Rabies Vaccine
Distemper Parvo Vaccine
Leptospirosis Vaccine
CIV Vaccine
Bordetella Vaccine
(2) Pyrantel Dewormings
(2) Fecal Tests
Heartworm test
Unlimited exams/office calls until one year of age
20% Discount on the cost of the Spay/Neuter
All vaccines listed above also include an appropriate number of boosters as determined by your veterinarian.

Furthermore, I understand the following conditions of purchase of this package in regards to the patient listed above:

I can purchase the package up to seven days after his/her first visit to have the covered services credited toward the purchase of the package.
This package is non-transferable between pets, but can be transferred to a new owner.
The refund policy to be applied only after full retail value for services rendered have been applied and can only be done within seven days of purchase.
The 20% discount on spay/neuter (1) does not include blood work or medications to go home and (2) must be completed before he/she turns one year old.
If I fail to bring him/her for any necessary booster vaccine(s) within the appropriate time frame of 4 weeks, I understand that it is my responsibility to pay the full retail price for any additional vaccine(s) he/she may require.
The Puppy Wellness Package is valid until he/she turns one year old, at which time it expires and it is not the responsibility of the veterinary clinic to notify me that it has or will expire.
This package does not include any items that are not listed above. Items not included in the package are additional tests, medications, nail trims, anal gland expressions, or preventative care such as heartworm or flea prevention that may be recommended by the veterinarian for your pet.

Please sign here:
[uacf7_signature* uacf7_signature-831]

Due to an increased number of missed appointments and last minute cancellations, the specialists we work with have instituted a strict cancellation policy. If you must cancel your appointment, we respectfully request two business days’ notice. Missed appointments, or appointments canceled without two business days’ notice, will incur a fee. As such, a deposit is to be paid upon scheduling an appointment with a specialist which will be non-refundable if adequate notice is not given prior to missing, canceling, or rescheduling the appointment.

Appointment Date:

By signing below you acknowledge the cancellation policy and agree to remit payment for the deposit within 24 hours to reserve your appointment date/time.

Please sign here:
[uacf7_signature* uacf7_signature-831]

Last Food or Water:

Signs of Illness
YesNo

Current Medication
YesNo

Reactions to Anesthesia
YesNo

Additional Questions or Concerns
YesNo

I verify I am the owner, or authorized agent for the owner, of the pet(s) named above and authorize the above procedure to be performed. I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian. I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always a risk associated with any anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. In the event of an emergency (please initial where appropriate),
I authorize the use of anesthesia and other medication as necessary.
I DO consent to the performance of CPR if necessary.I DO NOT consent to the performance of CPR.
I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. I understand no staff will be attending to my pet overnight (pets needing special care may be referred to a 24 hour hospital).
Please sign here:
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I verify I am the owner, or authorized agent for the owner, of the pet named above and authorize the clinic to treat my pet. I authorize the treatment plan that has been discussed with me in addition to the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that hospital personnel will be employed in the procedure(s) as directed by the veterinarian.
I have been advised as to the nature of this procedure to be performed and the risks involved. I understand also that there is always a risk associated with any anesthesia episode, even in apparently healthy animals and have discussed my concerns with the veterinarian. I understand that it may be necessary to provide medical and/or surgical procedures which are not anticipated for the safety or care of my pet. In the event of an emergency (please initial where appropriate),

I DO consent to and authorize the performance of CPR and/or altered or additional procedures as are necessary in the veterinarian's professional judgement. I accept responsibility for any result in additional charges which may be $300 - $500 or more depending on the situation.I DO NOT consent to and authorize the performance of CPR and/or altered or additional procedures as are necessary in the veterinarian's professional judgement.

I agree to be responsible for any charges incurred while my pet is in the care of this facility and understand payment is due at the time my pet is released from the hospital. I understand no staff will be attending to my pet overnight (pets needing special care may be referred to a 24 hour hospital). If I do not pick my pet up by the time the clinic closes for the day, I understand that I will be charged an overnight fee.
Please sign here: