Sick Reptile Form

Please fill out the reptile sick form below, and a member of our team will get back to you shortly. If you have any questions, please feel free to contact us.

APPOINTMENT

Sick Reptile Form

Please note any fields with * are required.

Owners Name *

First

Last

Email *

Pet Name *

Has your address changed since your last visit? *

Please enter your new address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

What Breed/Species is your exotic pet?

I understand the below policy regarding my pets prescriptions *

All written prescriptions must be requested at the time of your pet's appointment.
We will not write new prescriptions if you choose to change pharmacies.
In the event you must change pharmacies, you will need to contact the original pharmacy to have your prescription transferred.
You must submit all written prescriptions directly to the pharmacy of your choice.
Any written prescriptions requested outside of my pet's appointment today will require a $15 fee.
Medications filled from our in house or Vet's First Choice pharmacy can be obtained without any additional required fee's.

Please list requested medications that you would like to have refilled during your pets visit. *

To the best of your knowledge has your pet been diagnosed with any previous medical conditions? *

What is the problem your pet is experiencing today? Please describe symptoms and duration of symptoms? *

Has your reptile (if female) passed any eggs? If so, when and how many? *

Has there been any change in appetite, vomiting, or regurgitation? *

Have droppings looked normal? If not, please describe changes and appearance. Include if frequency of droppings has changed. *

Has there been any change in husbandry? (Temperature, UV lighting, caging, location of cage, stressful events, etc.) *

Has there been any change in diet? *

Is the pet supervised when out of the cage? *

Has the pet been seen at any other veterinary hospitals? *

I am the owner of the above Pet, or am acting as an agent for the owner, and accept full financial responsibility for any charges incurred during the pets visit. I hereby authorize the veterinarian to examine, prescribe for, or treat the above listed pets. I am aware that other personnel may be required in order to assist the veterinarian. Emergency cases shall always receive top priority, which is why occasional appointment delay is possible. We reserve the right to refuse to accept a pet at check-in for any reason, including without limitation due to illness or behavior. *

I have read and understand

For your protection, and that of others, we do not allow clients to assist in the restraint of pets, any owner that attempts to restrain or handle their pet while on the premises will be doing so at their own risk. I understand that my pet’s photos may be used for educational or media purposes. All dogs must be on a leash and properly controlled while on the premises. All cats and exotic pets must be presented in an appropriate carrier or on a leash. If you feel your pet may have been exposed to a potentially contagious disease please notify a CVCC staff member prior to the appointment. *

I have read and understand

We agree to provide the specific services ("Services") to your Pet for each visit as indicated on the estimate. We will exercise reasonable judgment in all circumstances as we provide the services. You agree to pay us for the Services we provide to your Pet during each visit at the rates set forth at the start of such visit (collectively the "Charges"). Prices are subject to change without notice and seasonal rates for boarding and grooming may apply. In the event you do not pay your bill in full at time of check-out, you agree that a fee of 1.5% per month (16% per annum,) will be charged. All collection and attorney fees necessary to collect this debt will be the responsibility of the owner or authorized agent. A returned check fee of $37 will be charged to your account each time we attempt to deposit the check and it is returned as insufficient funds. *

I have read and understand

Additional charges may be incurred when a pet is very difficult, exhibits risky behavior (biting, snapping, and intolerance to services in general) or has "soiling" behavior. These behaviors increase the amount of time that it takes to provide services for your pet. You acknowledge that we may contact appropriate authorities in the event your pet bites another pet or any person. *

I have read and understand

While your Pet is in our care, he or she may come into contact with other Pets. Every effort will be made to ensure the safety of our guests by enforcing strict restrictions. You acknowledge and agree that in the unlikely event your Pet is injured by another Pet, you hereby release CVCC from any liability for such injury. If your Pet injures another Pet, you will be solely responsible for any injury to the other Pet(s) as well as your own Pet. *

I have read and understand

You acknowledge and agree that in the unlikely event your Pet becomes ill or injured, or if your Pet passes away while on the premises, we will attempt to notify you via the telephone numbers you provided. If we cannot reach you, we at our sole discretion, may engage the services of our veterinarian or the area emergency veterinarian (which could be an outside facility) and/or administer medicine or give other necessary attention to your Pet, and you hereby authorize us to provide any such service at your additional expense. You also waive the right to refuse medical treatment to make the pet comfortable or stabilize the pet while under our care and any such service will be provided at your additional expense. If at any time your pet is found to have fleas or ticks while on the premises, we will provide the appropriate flea or tick removal treatment, and you hereby authorize us to provide such service at your additional expense. *

I have read and understand

Pets under the care of the veterinarian must be discharged by close of business for the day, otherwise the pet will be boarded at the nightly rate until the next business day. *

I have read and understand

We will not be responsible for any accidental death of the pet(s) due to the nature of any pre-existing health condition. We also will not be held responsible for minor nicks resulting from the grooming of matted, neglected coats or for irritation caused by removing coat from pets possessing mild to severe skin allergy, nor will we be held responsible for stressful effects that grooming may have upon a pet. We, as ethical groomers, reserve the right to refuse to demat a pet UNLESS we deem that the pet can tolerate the amount of dematting and that it could be done humanely. *

I have read and understand

All Pets are required to be vaccinated; however, it is still possible for a Pet to become ill, even if vaccinated. You agree that we are not liable for any illness suffered by your Pet during or after its stay. *

I have read and understand

Do not bring items with your Pet that are valuable or irreplaceable, We are not responsible for loss or damage to any personal item or toy left with your Pet. *

I have read and understand

If the pet is not called for at the time of the scheduled pickup date, we have the right to contact appropriate authorities as we see fit (in most cases local animal control officers) within ten (10) days after this date. The owner will receive one (1) notification by registered mail during this period no further notice will be given prior to a decision being made. *

I have read and understand

By signing you are indicating that you are the responsible party as an adult over the age of 18. You agree that you have full and complete authority to make all decisions, including those related to the expenditure of funds, for or on behalf of you and your pet and that you have had the opportunity to discuss it with us your satisfaction, and you agree to its terms. *

I have read and understand

Signature *

Clear Signature

Date *

Sick Reptile Form

Sick Reptile Form

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