Registration Form -

Client Information

Name

First Last

Phone

Email

Patient Information

Name of pet

Species

Breed

Color

DOB

Consent

Treatment Authorization*

√ 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.

Appointment Cancellation Agreement*

√ Four Paws Veterinary Wellness is dedicated to providing exceptional care to all our patients. Our appointments are in high demand but because we are mobile and travel is required, cancelation without adequate notice prevents another patient from being seen.

Clients wishing to cancel or reschedule appointments must give at least 24 hours notice. To cancel or reschedule Monday appointments, we require a call by Friday at 9 am.

If an appointment is canceled with less than 24 hours notice, an examination including a travel fee will be charged. If we arrive at a client’s home and no one is home, the same will apply. If an appointment is rescheduled more than once, pre-payment for the examination/consultation will be required. Canceling or rescheduling must be done by telephone . Call Us at: 734-385-7161

Alternative Venue Treatment Agreement*

√ 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*

√ 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*

√ 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.

Acknowledgement and Agreement of All Terms*

√ By checking this box and submitting this form, I acknowledge that I have read & understood all terms outlined in the form, and that I have completed the form to the best of my knowledge.

Signature*

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Registration Form

Client Information

Patient Information

Consent

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