Name
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First Name
Last Name
Email Address
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Occupation
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Preferred Phone Contact Number
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Mobile
(###)
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Text OK?
Home
(###)
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Work
(###)
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Secondary Caregiver
First Name
Last Name
Phone Number
(###)
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Occupation
Pet's Name
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Species
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Breed
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Sex
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Spayed / Neutered
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Does your puppy have any health issues or concerns?
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Current Diet
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Please tell us everything about your pet's current diet. Include details about your pet's appetite, typical daily feeding routine, type of food (dry/wet/raw), brand(s), flavor/protein, amount given per meal, any treats, human food, fruits/veggies, etc. Please be as specific as possible.
Veterinary clinics my pet has been to:
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Please list all Veterinary clinics and phone numbers your pet has been to.
Flea and Tick Preventative
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Depending on your pet's behavior and where you live, flea and tick prevention may not be needed at all. We recommend using high quality essential oils, daily brushing, and/or herbal supplements that provide natural flea and tick prevention before utilizing medication. Check out our website for more information!
Current Medications / Supplements being given:
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Please list all medications with strength and dosages and list any supplements currently in use as well.
My pet's personality:
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Are they generally playful, fearful, worried, happy? What are their likes/dislikes? Fears and phobias? Please describe in full detail.
How is your pet during veterinary exams?
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Is there anything we need to be aware of? Do they get nervous and hide? Do they not like certain parts of their body being touched.
How were you referred to our practice?
What days are good for you?
9:00am-4:30pm
I understand that I need to call my conventional veterinarian to send records to SAAC. IMPORTANT: Clients with records will be called first.
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Please call our office to confirm that your records have been sent to us.
Phone: 586-884-0882.
We cannot set up an appointment without all records being sent. Fax: 586-314-0249 / Email: sheppardanimalcare@gmail.com
Due to high demand and a full schedule, I understand that a $100.00 deposit will be required to make the new patient appointment to hold your space in our calendar. . This deposit will be applied at the time of your appointment.
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Video Thoughts
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Please tell us any other immediate reactions or thoughts you have after viewing these videos.
