Registration Form -

Client Information

Cancellation Policy Agreement*

I understand that Four Paws Veterinary Wellness is dedicated to providing exceptional care to all our patients. Four Paws' appointments are in high demand. I understand that missed appointments or cancelation without adequate notice prevents another patient from being seen.

I agree to give Four Paws at least 48 hours notice for cancelations or rescheduling of appointments.

Cancelling or rescheduling a Monday appointment requires a call by Thursday at 9am. If an appointment is canceled with less than 48 hours notice, the full examination fee will be charged.

I understand that canceling or rescheduling must be done by telephone 734-385-7161

Name

First Last

Preferred Pronouns

If you do not see your preferred pronouns below, please use the "Other" option to includes yours.

She/Her/Hers
He/Him/His
Them/They/Theirs

Preferred Pronouns

Phone

Email

Patient Information

Name of pet

Species

Breed

Color

DOB

What medication(s) and/or supplement (s) is your pet currently taking? Please include amount and frequency. If your pet is not on any medications just write "none taken".*

What is your pet's diet and how often do you feed them?*

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.

Acknowledgment of Required Forms Communication*

I understand that the links to all requested forms are found in the Four Paws appointment confirmation/reminder emails.

Required Forms*

I understand that all requested forms must be submitted 24 hours prior to the appointment. Four Paws reserves the right to cancel my pet's appointment if these forms are not submitted and I may be charged the full fee for the appointment.

Cancellation Terms & Acknowledgement*

I understand that at least 48 hours notice is required for canceling or rescheduling my pet's appointment. To cancel or reschedule a Monday appointments, I must notify Four Paws no later than the previous Thursday at 9am. If an appointment is canceled with less than 48 hours notice, I understand the full examination fee will be charged. I understand that canceling or rescheduling must be done by telephone 734-385-7161.

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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Typed Signature*

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Date*

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