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If you were referred to us by a friend or family, please let us know who to thank!

Pet's Name

Breed

Color

Age/Date of Birth

Allergies/Conditions

Current Medications (including heartworm and flea prevention)

Second Pet

Second Pet's Name

Second Pet's Breed

Second Pet's Color

Age/Date of Birth

Second Pet's Allergies/Conditions

Second Pet's Current Medications (including heartworm and flea prevention)

Third Pet

Third Pet's Name

Third Pet's Breed

Third Pet's Color

Age/Date of Birth

Third Pet's Allergies/Conditions

Third Pet's Current Medications (including heartworm and flea prevention)

Previous Veterinary Hospital (please write "none" if no veterinary history available)

Who is your pet insurance provider? (if applicable)

Please list all veterinary practices or other partners such as boarding locations to which we have permission to send medical records.

Please read the following to give informed consent for our policies and procedures: ALTERNATIVE TREATMENTS

I understand that Alma Vet Connection offers both traditional/conventional veterinary care AND alternative care modalities. These modalities may include:

Acupuncture
Herbal Medications
Ozone Therapy
Tui na Massage Techniques
Food Therapy
Homeopathic Remedies
Veterinary Orthopedic Manipulation
Ultraviolet Blood Irradiation
Pulsed Electro Magnetic Frequencies

I understand that the safety and/or effectiveness of some alternative modalities may not be well-established and/or are deemed “experimental” according to the American Veterinary Medical Association and/or the U.S. Food and Drug Administration. I also understand that, although rare, the potential for adverse reactions to some of these treatments exists.

I agree that Alma Vet Connection has explained, in sufficient detail to understand and with the opportunity to ask questions, the alternative treatments above so that I can make an educated decision on their use for my pet. I also realize that I have the option to do nothing if I so choose.

OFF LABEL USAGE

I acknowledge that, due to manufacturer supply limitations and FDA regulations, it is a common veterinary practice that some medications prescribed or administered may be compounded or used “off label.”

PAYMENT

I accept ALL financial responsibility and understand that all professional fees are due at the time of services. I understand that additional charges may apply when applicable, such as a missed appointment fee or an emergency work-in fee.

EMERGENCY CARE

In the event of an emergency, if I am not present, I understand that every attempt will be made to contact me. I hereby give permission for any reasonable treatments needed to stabilize my pet to be done or given in the event of said emergency, unless specifically discussed otherwise, such as during admission to the hospital for anesthesia/surgery.

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