STEP 1: CALL TO HAVE PET'S VET RECORDS SENT TO US FAX: 586-314-0249 EMAIL: SHEPPARDANIMALCARE@GMAIL.COM

Before you submit this New Patient Form, please call all of the vet clinics your pet has ever seen and have them send over all records for your pet to us. Please know that we have many new patient inquiries and will choose the ones who have their records sent first, so it's important.

STEP 2: PET OWNER INFORMATION

Name

First Name

Last Name

Occupation

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone Contact Number:

Mobile

Home

Work

Mobile

(###)

###

####

Text OK?

Yes

Home

(###)

###

####

Work

(###)

###

####

Secondary Caregiver

First Name

Last Name

Phone

(###)

###

####

Occupation

STEP 3: PET INFORMATION

Pet's Name

Species

Canine

Feline

Breed

Sex

Female

Male

Spayed/Neutered

Yes

Date of Birth

Approximate date or age if not known

Where did you obtain your pet?

Include the age as well. Example: Breeder @ age 8 weeks. Rescued from Best Friends Rescue around age 8 months.

Explain your pet's current problem and what it is you are hoping we can do for them.

Name of other pet(s) that we currently see:

STEP 4: PET DIET

Current Diet

Please tell us everything about your pet's current diet. Include details about your pet's appetite, typical daily feeding routine, type of food (dry/wet/raw), brand(s), flavor/protein, amount given per meal, any treats, human food, fruits/veggies, etc. Please be as specific as possible.

How long has this current diet been fed?

Drinking water:

What type of water are you offering your pet?

STEP 5: PET HEALTH HISTORY

Veterinary clinics my pet has been to:

Please list all Veterinary clinics and phone numbers your pet has been to.

Vaccination Comments

We have found that over-vaccination causes chronic health issues. At our office, we do a minimal vaccination protocol. Initial vaccinations create immunity that lasts years, rendering annual vaccinations useless. To prove this, we do annual titer testing. Titer testing is a quick in-office blood test that measures antibody levels from previous vaccinations. This test will tell us if your pet has sufficient immunity and whether or not another vaccination is needed. There are some vaccinations that we do not even recommend such as Bordetella. In lieu of these vaccinations, we put our focus on nutrition and strengthening the immune system.

Heartworm Preventative

We believe overmedicating can cause more harm than good. Our protocol is to do an annual in-office heartworm test, then give heartworm tablets every other month from July to November (that is 3 doses per year for dogs living in Michigan.) Check out our website for more information.

Flea and Tick Preventative

Depending on your pet's behavior and where you live, flea and tick prevention may not be needed at all. We recommend using high quality essential oils, daily brushing, and/or herbal supplements that provide natural flea and tick prevention before utilizing medication. Check out our website for more information.

STEP 6: PET ILLNESS HISTORY

List all illnesses your pet has experienced:

Please list these in order from oldest issues to most recent. Examples include skin allergies, ear infections, eye infections, and more severe issues.

Current Medications/ Supplements given:

Please list all medications with dosages and list any supplements currently in use as well.

Other stressful experiences my pet has had:

List any accidents / injuries / surgeries / dental procedures. Please describe along with approximate dates / ages.

STEP 7: PET EMOTIONAL & BEHAVIORAL ASSESSMENT

My pet's personality:

Are they generally playful, fearful, worried, happy? What are their likes/dislikes? Fears/phobias? Please describe in detail.

These are all the pets in my home:

Please list the pets in their home, their names, what type of pet they are their age.

How is your pet during veterinary exams?

Is there anything we need to be aware of? Do they not like certain parts of their body touched?

I understand that I need to call my conventional veterinarian to send records to SAAC.

Please call our office to confirm that your records have been sent to us. Phone: 586-884-0882. We cannot set up an appointment without all records being sent. Fax: 586-314-0249 / Email: sheppardanimalcare@gmail.com

Yes

Due to high demand and a full schedule, I understand that a $120.00 deposit will be required to make the new patient appointment. This deposit will cover your exam fee.

Yes

Current Client, New Pet