New Client Form Thank you for giving us the opportunity to care for your pet. Please help us to better meet your needs by taking a moment to complete this information.Owner's Name(Required) First Last Cell Phone(Required) Home Phone Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Who else is authorized to make decisions about your pet’s healthcare (Name and Phone Number)(Required) Is this person to be listed as a second owner? Yes No Emergency Contact Name(Required) Emergency Contact Phone(Required) Is this person to be listed as a second owner? Yes No Who Can We Thank For Referring You To Our Hospital? Preferred Payment Method Cash Credit Card Care Credit We will gladly prepare an estimate upon request, please ask the customer service representative, the nurse, or the doctor. A deposit may be required for surgery or hospitalization. I hereby Authorize the veterinarian to examine, prescribe for, and/or treat my pets. I assume full responsibility for all charges incurred for the care of all my pets on my file. I also understand that these charges will be paid at the time services are rendered. Collection services/attorney fees will be levied on all unpaid balances.(Required) I Understand Reminder Method: Rox Falls Vet uses Email and Text Message for Vaccine/Exam reminders and Appointment Confirmations. Please initial to indicate your approval to use these methods of communication(Required) I Understand To prevent the spread of infectious diseases and parasites, hospitalized and boarded animals must be current on all vaccines and free of internal and external parasites. I authorize the doctor to administer vaccines and parasite control as needed for my pet.(Required) I Understand I accept that there are potential risks with any vaccination, medication, or treatment provided. I accept that there is also potential risk with declining medical recommendations. I understand and release Rox Falls Vet of any liability associated. I understand it is my responsibility to contact Rox Falls Vet or seek care at an Emergency Hospital if any adverse reaction has occurred.(Required) I Understand Veterinary Hours DisclosureRox Falls Vet is continuously staffed by medical and business personnel during the following hours: Monday –Thursday: 9 AM to 7 PM (Doctor’s Hours 9AM to 6:30PM) Friday-Saturday-Sunday: 9 AM to 5 PM (Doctor’s Hours 9AM to 4:30PM) This schedule may be subject to change. Clients are referred to the website www.roxfallsvet.com and the Hospital Facebook page for most up to date hours or for emergency closings. Staffing is not provided at other hours or on the following holidays: New Year’s Day, Easter, Memorial Day, Fourth of July, Labor Day, Thanksgiving, Christmas, Yom Kippur. Patients requiring continuous monitoring and medical treatment (i.e. intensive care) at times this hospital is closed can be transferred by the owners or their agent to a 24 hr facility where after hours staffing is provided. Any expenses incurred at another facility will be the responsibility of the owner. I have read this form, and I am aware of the staffing hours.(Required) I Agree Date(Required) MM slash DD slash YYYY Signature (Owner/Agent)(Required)PET INFORMATION #1Pet Name(Required) Species(Required) Feline Canine Other If Other Breed(Required) Color(Required) Age/DOB(Required) Sex(Required) Spayed or Neutered(Required) Yes No Unknown Is your pet currently up to date on vaccines?(Required) Yes No Please provide the name of your previous veterinarian(Required) Do we have permission to contact the previous veterinarian for records?(Required) Yes No Microchipped?(Required) Yes No Unknown Number PET INFORMATION #2Pet Name Species Feline Canine Other If Other Breed Color Age/DOB Sex Spayed or Neutered Yes No Unknown Is your pet currently up to date on vaccines? Yes No Please provide the name of your previous veterinarian Do we have permission to contact the previous veterinarian for records? Yes No Microchipped? Yes No Unknown Number PHOTO RELEASEI grant Rox Falls Vet, its representatives and employees the right to take photographs of me and my pet(s). I authorize Rox Falls Vet, its assigns and transferees to copyright, use and publish the same in print as well as electronically. I agree that Rox Falls Vet may use these photographs of me and/or my pet(s) with or without my name for any lawful purpose, including use on Facebook / Instagram, on the Rox Falls Vet website, and in our clinic.(Required) I Agree I Decline RFV APPOINTMENT CANCELLATION/NO-SHOW POLICYDeposits will be required when booking the following types of appointments: All Urgent Care appointments on Fridays, Saturdays, and Sundays. First-time Patient Wellness appointments on Fridays, Saturdays, and Sundays. Multiple Pet appointments on the same day. Appointments of any type after missing a previous appointment without calling to cancel at least an hour in advance. *ALL DEPOSITS WILL BE THE COST OF THE MEDICAL CONSULT FEE FOR EACH PET AND WILL BE APPLIED TO THE FINAL INVOICE. If a cancellation is made at least 1 hour before the scheduled start time, the deposit will be refunded. If a cancellation, reschedule due to tardiness, or no show occurs within 1 hour of appointment, the deposit will be forfeited. ROX FALLS VET PHARMACY RECOMMENDATIONRox Falls Vet has both an in-hospital pharmacy, and an online pharmacy hosted by My VetStore Online at the URL, https://roxfallsvet.myvetstoreonline.pharmacy. It is important to understand the benefits of using our pharmacy compared to the national online pharmacy chains. Better record keeping and medical record accuracy - Ensure refills are on schedule so your pet is getting medication as needed. Convenience – Refill requests to Hospital are filled within 24 hr notice via email or phone call Knowledge – Our veterinary team has more customized knowledge of the medication, including extra label usage, compared to a pharmacy team. The latter is not as familiar with veterinary specific uses for medication as well as the need to not include pet toxic substances such as xylitol often used on human medications. Product guarantees – Guarantees offered by manufacturers are often only honored if the medication is purchased through a veterinary pharmacy. Competitively priced – Rox Falls Vet online pharmacy is competitive with other online pharmacies. Ground shipping is free for orders over $49. External online pharmacies such as Chewy or 1-800-PetMeds flood veterinary hospitals with requests for medications, often pulling our staff away from providing veterinary care. The staff time required to process, verify these prescriptions, and correct errors is significant. Rox Falls Vet can better control dosages, instructions, and authenticity of product when purchased through our pharmacy. We will give you a written prescription upon request that you can mail into their pharmacy or upload to their portal. Support our local family-owned practice to help us support our staff, equipment, and facility so that we can provide the best care. Rox Falls Vet is your neighbor, and we see our pet parents as much more than a financial transaction from a distant corporate office. External Online pharmacies such as Chewy or 1-800-PetMeds flood veterinary hospitals with requests for meds, often pulling our staff away from providing veterinary care. The staff time required to process and verify prescriptions, and correct errors is significant. Rox Falls Vet can better control dosages, instructions and authenticity of product when purchased through our pharmacy Thank you for your understanding and support! Rox Falls Vet has both an in-hospital pharmacy, and an online pharmacy hosted by My VetStore Online at the URL, https://roxfallsvet.myvetstoreonline.pharmacy. It is important to understand the benefits of using our pharmacy compared to the national online pharmacy chains. Better record keeping and medical record accuracy - Ensure refills are on schedule so your pet is getting medication as needed. Convenience – Refill requests to Hospital are filled within 24 hr notice via email or phone call Knowledge – Our veterinary team has more customized knowledge of the medication, including extra label usage, compared to a pharmacy team. The latter is not as familiar with veterinary specific uses for medication as well as the need to not include pet toxic substances such as xylitol often used on human medications. Product guarantees – Guarantees offered by manufacturers are often only honored if the medication is purchased through a veterinary pharmacy. Competitively priced – Rox Falls Vet online pharmacy is competitive with other online pharmacies. Ground shipping is free for orders over $49. External online pharmacies such as Chewy or 1-800-PetMeds flood veterinary hospitals with requests for medications, often pulling our staff away from providing veterinary care. The staff time required to process, verify these prescriptions, and correct errors is significant. Rox Falls Vet can better control dosages, instructions, and authenticity of product when purchased through our pharmacy. We will give you a written prescription upon request that you can mail into their pharmacy or upload to their portal. Support our local family-owned practice to help us support our staff, equipment, and facility so that we can provide the best care. Rox Falls Vet is your neighbor, and we see our pet parents as much more than a financial transaction from a distant corporate office. External Online pharmacies such as Chewy or 1-800-PetMeds flood veterinary hospitals with requests for meds, often pulling our staff away from providing veterinary care. The staff time required to process and verify prescriptions, and correct errors is significant. Rox Falls Vet can better control dosages, instructions and authenticity of product when purchased through our pharmacy(Required) I understand the pharmacy rules CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
Rox Falls Vet is continuously staffed by medical and business personnel during the following hours:
Monday –Thursday: 9 AM to 7 PM (Doctor’s Hours 9AM to 6:30PM)
Friday-Saturday-Sunday: 9 AM to 5 PM (Doctor’s Hours 9AM to 4:30PM)
Deposits will be required when booking the following types of appointments:
*ALL DEPOSITS WILL BE THE COST OF THE MEDICAL CONSULT FEE FOR EACH PET AND WILL BE APPLIED TO THE FINAL INVOICE.
If a cancellation is made at least 1 hour before the scheduled start time, the deposit will be refunded. If a cancellation, reschedule due to tardiness, or no show occurs within 1 hour of appointment, the deposit will be forfeited.
Rox Falls Vet has both an in-hospital pharmacy, and an online pharmacy hosted by My VetStore Online at the URL, https://roxfallsvet.myvetstoreonline.pharmacy. It is important to understand the benefits of using our pharmacy compared to the national online pharmacy chains.
Thank you for your understanding and support!
