New Patient intake form | Doorbell Vet

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MEDICAL EMERGENCY

Client Intake Form For New Patients

If you have trouble completing this form please call the office at (585) 441-0200 and one of our client service representatives will get back to you to assist during business hours.

Sex

Female

Male

Spayed

Neutered

Has your pet had any coughing, sneezing, vomiting, diarrhea, limping, scratching, lump, vaccine reactions or need for calming medication

Coughing

Sneezing

Vomiting

Diarrhea

Limping

Scratching

New Lumps or Bumps

History of vaccine reactions

Need for calming medication

Please Describe

How did you hear about us and why are you interested in housecalls?

What is your availability for scheduling and how soon do you need to be seen?

I understand that Doorbell Vet is not an emergency clinic and available by appointment only

I will be prepared for our team to show up plus or minus 30 minutes from the scheduled appointment time.

I give permission to use photo/case information in advertising/blog

I understand payment is expected at the time of service and includes credit card or cash only

Where has your pet been seen previously?

We need your pets recent vet records! Please upload below or have them emailed to info@doorbellvet.com or faxed to (866) 670-9789

Upload File

Upload supported file (Max 15MB)

Feel free to send us a cute photo of your pet!

Upload Photo

Upload supported file (Max 15MB)

Thanks for submitting! We will get back to you within 1 business day

If you have additional pets you would like seen, please register them HERE

Areas we service:

Rochester | Webster | Victor | Fairport | Irondequoit | Greece | East Rochester

Henrietta | West Henrietta | Brighton | Pittsford | Penfield | Mendon | Gates | Chili | Rush | Honeoye Falls

Disclaimer

The information on this website is only for information purposes and does not replace the advice of your veterinarian. All pets are individuals and without examining your pet it is impossible to give you accurate medical advice. Always check with your veterinarian before using any information you read on this site. The advice and comments found on this site are not a substitute for professional medical diagnosis, treatment or advice. Dr. Dori Marion and Doorbell Vet are not responsible for any damage, illness, death or harm that occurs from information found on this site or links from this site to other resources

© 2016 Doorbellvet.com by Dori Marion.

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