Client Information Consent (Required) Name
If you do not see your preferred pronouns below, please use the "Other" option to include yours.
Patient Information In order for Dr. Turenne to review your pet's history, it is important that we have veterinary records for your pet over the past 3 years. Please list any veterinary hospitals/clinics your pet has been to in the past 3 years. This includes any general medicine hospitals/clinic as well as mobile practices and specialty practices (orthopedics, cardiology, internal medicine, etc.). Treatment Authorization (Required) I hereby authorize Monica Turenne, DVM, and her employees to examine, treat and prescribe for my pet(s). I assume responsibility for all charges incurred in the care of this pet(s). I understand that these charges will be paid at the time of service. √ Client Information Alternative Venue Treatment Agreement (Required) To provide comprehensive and thorough care, sometimes work is required outside of in-home visits. Examples would include prolonged work collaborating with other providers, an extensive review of medical records, and replying to clinical questions by email, text or phone, writing letters, and filling out long forms. i understand that this work will be charged at $ 60 for up to 30 minutes. √ Medication and Supplement Agreement (Required) I understand that medications and supplements cannot be returned unless they are defective. Notification of defective products must be made to our office within 48 hours of purchase. √ Doctor Supplement Review Agreement (Required) I understand that there are an unlimited number of supplements available to treat various conditions in veterinary medicine, including cancer, allergies, gastrointestinal disease, endocrine disease, etc. Dr. Turenne has studied for many years and devoted much time to determine which supplements and herbs provide quality, safety, and efficacy for her patients. If you have supplements you would like Dr. Turenne to review, in most cases, she will only be able to comment on whether the ingredients in the products are generally known to be helpful but cannot make any claims as to the efficacy, safety or quality of the products. √ COVID-19 PROTOCOLS
Four Paws is committed to ensuring the health and safety of all your family members (both 4 and 2 legged). We have been and will continue to monitor developments regarding Covid-19 and the guidance of Governor Whitmer, the AVMA, the CDC, and the Michigan Veterinary Medical Association.
Through this crisis, we have and continue to learn many important lessons, on one which is that we truly are all in this together and that we must continue to work together to keep each other safe.
The following policies and protocols have been implemented to limit the exposure between houses and protect our clients, pets, and staff. Please keep in mind that we are not at full-staff and we are working very hard to meet your requests and the needs of your pets. We ask that you please be patient with us as we navigate through this process
All policies are subject to change. GENERAL POLICIES
1. Most appointments will have pre-screening by telephone or Zoom the day before the in-person appointment. During this appointment, we will discuss how your pet is doing, your main concerns, bloodwork needed, any herbs or supplements requested, etc. It the appointment is for an annual examination, what vaccines (or titers) will be needed and what preventive medications are requested.
These pre-screening appointments will be approximately 15-30 minutes and will be scheduled at the time you schedule your in-person appointment.
2. Weather permitting, dog appointments will be seen in a garage, screened in porch or outside. Whether this is appropriate for your pet’s situation can be discussed at the pre-screen appointment.
3. We require that cats be in a carrier/crate on our arrival. The normal “cat wrangling” that we do in some cases will not take place during this time to limit exposure time. If your cat is not confined at the time of the appointment will be rescheduled and an examination and travel fee will be charged.
OUR COMMITMENT TO YOU
Four Paws employees who have contact with clients will have their temperatures taken in the morning prior to being allowed into the workplace. If temperatures are > 100 degrees F, the employee will be sent home (current CDC guidelines are >100.4 degrees F). If the employee or any member of their family is clinically ill, the employees will stay home. This could result in needing to reschedule or cancel your appointment.
We will only be bringing in the necessary equipment and tools needed for the examination. We will not bring in our scale(s) for every appointment. Everything will be thoroughly disinfected between appointments.
We will be adhering to 10 foot social distancing requirements. In some cases, you may not be present for the examination.
All employees will wear masks and gloves during appointments.
We will call you if we are running late. Otherwise, please expect us at the time of the scheduled appointment and please have your pet ready.
For dogs, we will do a leash transfer, utilizing our own leash
If you are not present for the examination, Dr. Turenne will contact you by email following the appointment to discuss her findings and recommendations.
Please check the box next to the statement to indicate an understanding and acceptance of the policy.
Consent (Required) I understand that Four Paws employees will wear masks at all times during my pet’s appointment. √ (Required) Consent (Required) When requested, I will schedule a pre-screen appointment when I schedule my pet’s in-person appointment.* √ (Required) (Required) I understand that if a pre-screen appointment is required but is missed or canceled, the in-person appointment cannot take place.* √ Consent (Required) If I am sick or a family member is sick, even if the signs are mild, if I have been quarantined after travel or if I have been exposed to someone who had tested positive for Covid-19, my pet’s appointment must be rescheduled √ (Required) Consent (Required) I understand that weather permitting, my dog’s appointment may be performed outside or in a garage w/ the door open √ (Required) Consent (Required) I understand that my cat will be confined at the time of the appointment. If my cat is not confined, the appointment will be rescheduled and an examination and travel fee will be charged. √ (Required) Consent (Required) I understand that there may be instances my pet may be seen in the back of our sport utility vehicle. I understand that 2 rows of seats will be laying flat to allow for ample room to maneuver. √ (Required) Consent (Required) I will have my pet in the pre-determined location on Four Paws arrival √ (Required) Consent (Required) I understand that I may not be able to be present for my pet’s examination √ (Required) Consent (Required) I will wear a mask during my pet’s appointment √ (Required) Consent (Required) I understand that if I do not adhere to the Covid-19 guidelines, Four Paws has the right to end the appointment and an exam and travel fee will be charged in addition to any services that take place during the appointment. √ (Required) Consent (Required) I will discard any trash generated by Four Paws staff during my pet’s appointment (other than needles and other sharps). The trash will be left neatly in a large zip lock bag √ (Required) (Required) I agree to payment via credit card following the in-person appointment. √ (Required) Client Consent
Please sign and date before submitting
Consent (Required) By checking this box and the above boxes, I agree to these policies and protocols. Please note that upon submitting this form I enter into agreement with the above protocols required of Four Paws Wellness. √ Telemedicine Consent Owner Consent (Required) I certify I am the legal owner/authorized agent for the owner of the companion animal described above and give Four Paws Veterinary Wellness, and any authorized agents, staff, or representatives full and complete authority to use telemedicine to evaluate, diagnose and treat the above-described companion animal. I agree that Four Paws Veterinary Wellness, and any authorized agents, staff, or representatives shall not be liable for any direct, indirect, or consequential damages resulting from such telemedicine √ Telemedicine Limitations Agreement (Required) I understand there are limitations with telemedicine and that an in-personal physical examination may be recommended. √ Medication Agreement (Required) I understand that there are some circumstances in which we are not able to prescribe medications for telemedicine patients without a physical examination. √ Pet Present During Telemedicine Appointment (Required) I understand that my pet must be present during the telemedicine consultation. √ Telemedicine Technical Difficulties Agreement (Required) I understand that technical difficulties may occur before or during the telemedicine session and my pet’s appointment may not start or end as intended or may be interrupted if there are technical difficulties. √ Telemedicine Disclaimer (Required) I understand that telemedicine is NOT an emergency service and in the event of an emergency, I will contact my primary care veterinarian or an emergency veterinary service. √ Acknowledgement (Required) By checking this box and submitting this form, I acknowledge that I have read & understood all terms outlined in all aspects of this form, and that I have completed the form to the best of my knowledge. Signature (Required)
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