Existing Client Form - Trenton Pet Hospital

Your Contact Information

Name*

First Last

Email*

Telephone Phone Number

Are you looking to book an appointment?*

Yes
No

Appointment availability, types and lengths vary. Please list a few dates/times that may work best for you.

If you are looking to book an appointment, please tell us what you would like to book your pet for:

Your Pet's Medical Information

Pet's Name

Does your pet have any chronic medical conditions?

If yes, please describe:

Does your pet have any allergies?

If yes, please describe:

Fear Free Questions

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

Does your pet show reluctance to getting in a pet carrier or vehicle?*

Yes
No

How does your pet travel when in a vehicle?*

How does your pet behave in the vehicle?*

Vocal/Barking/Whining
Restless/Pacing
Panting
Drooling
Trembling
Perfectly

Are there things you or your pet did not like during past veterinary visits?*

Being weighed
Getting on the exam table
Having a procedure done
Being handled
Walking through the clinic
Other

Has your pet ever been prescribed any medication to help with previous veterinary visits?*

Yes
No

I/we hereby authorize the veterinarians to examine, prescribe for, or treat my pets (s). I/we assume full responsibility for all charges incurred in the care of this/these animal(s). I/we also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures.*

I have read and understand.

I/we have read, understood and agree to abide by Trenton Pet Hospital's Civility Policy.*

I have read and understand.

Team members of Trenton Pet Hospital will treat each other and members of the public with respect. The same treatment is expected in return.

This policy is intended to promote mutual respect, civility and orderly conduct among clinic team members and the public. This policy is not intended to deprive any person of his or her right to freedom of expression, but only to maintain a safe, harassment-free workplace. TPH seeks public cooperation with this endeavor.

To read the entire policy, visit trentonpethospital.com/civility-policy

Type Signature*

Existing Client Appointment Request

Existing Client Appointment Request

Your Contact Information

Your Pet's Medical Information

Fear Free Questions

Address

Business Hours

Contact Info