The Official Form that Gets the PAZ Appointment Party Started: (Please only use if you like efficiency and awesomeness) Date* MM slash DD slash YYYY Patient's Name (first and last, please).* Phone Number (the one we should use during your appointment).* Is this a wellness / preventive care visit or a sick / active problem visit? Wellness / Preventive Care Visit Sick / Active Problem Visit Are there any particular issues or concerns you'd like the doctor to look at or discuss at this visit?In your own words, what's going on?Have you completed this form for a recent visit and there's no new diet or medication / supplement information to provide?* Nope, there's new info to share. Yes, all the proverbial beans were spilled last time and there's no new tidbits to share. You're finished! Please press the submit button. We look forward to seeing you again! What food and how much per day is your pet currently eating? If you've been feeding this for less than 1 month, what were you feeding prior?What treats do you feed your pet and (roughly) how frequently?What heartworm and flea/tick preventives are you using to protect your pet? When was the most recent dose given? (If you need refills on preventives, this is a good place to let us know).Please list all medications, if any, that your pets is currently receiving (name, strength, & frequency).What, if any, supplements or herbal medications have you given your pet within the last week?For many reasons, it is possible for pets to experience fear and/or stress at the vet. Will you be giving any medication or supplement to help your pet with anxiety prior to the appointment? Nope, my pet loves coming to PAZ! Nope, my pet is usually anxious/scared at the vet, but I'm not planning on giving anything to help with anxiety. Yes, I will list below what specifically will be given and tell how well I feel it has worked in the past. Anxiety medications/supplements for this visit (name, dosage, and planned time).Authorization & Digital Communication Consent I authorize the hospital to release my pet’s medical information to other veterinary hospitals, groomers, and kennels, including my phone number if my lost pet is recovered. I acknowledge that conversations during my pet’s visit may be recorded for quality assurance and service improvement purposes. I hereby grant the hospital all rights, title, and interest in any photographs, images, videos, or audio recordings of my pet or myself taken during my pet’s visit. This includes the use of such materials for promotional purposes, on the hospital’s website, and other marketing materials. If the veterinary team determines that immediate treatment is necessary for the health and well-being of my pet, and I or my co-owner are unable to be reached, I consent to the administration of all reasonable treatments recommended. I assume responsibility for all charges incurred for my pet(s) and understand that payment is due at the time services are rendered. I understand that the hospital offers various forms of digital communication to keep me informed about my pet’s health, remind me of upcoming appointments, and share promotions and health tips. By signing below, I authorize the hospital to contact me via email, phone, and/or text message (SMS). I understand that I can opt out of these communications at any time by following the unsubscribe instructions in any communication received.
