: 469.716.4211

NOW ACCEPTING NEW PATIENTS

New Client Form

Please take a moment to fill out the following form to allow us to create an accurate record for you and your pet by completing the following information.

First Name

Last Name

Middle Initial

Phone Number

Street Address

City

Postal / Zip code

Would you like to receive text message and email updates to stay informed about appointments and other important practice news?

Yes

Would you like access to the NaVetor App for access to pets medical records, scheduling appointments, and viewing appointments?

Yes

Company

Co-Owner First Name

Co-Owner Phone Number

Occupation

Co-Owner Last Name

Co-Owner Email

Is the Co-Owner an Authorized Agent? (Ability to make financial decisions)

Yes

Pet 1

Pet's Name

Breed

Age

Where did you get your pet?

Color

Does your pet receive Heartworm, flea, and tick prevention?

Yes

Does your pet have any pre-existing medical conditions? If so please explain...

Is your pet currently taking y mdications or supplements? If so please list medications and if refills are needed...

Does your pet have any food allergies or sensitivities we need to be aware of?

Yes

Please list any known allergies.

Please list your previous Veterinarian's information

May we contact your previous Veterinarian?

Yes

Please upload a copy of your pet's records.

Upload File

Do you have additional pet's?

Yes

Please list Name, Species, Age, Sex of additional pet's in the household.

Professional fees are to be paid at the time services are rendered. We do not carry open accounts and do not offer payment plans, however, we do accept the following methods of payment:

Case, Visa, Mastercard, Discover, American Express, and Scratchpay.

*There is a service charge for credit card payments.

We can provide you with a written diagnostic and/or treatment plan of fees for any case upon request. Diagnostic and/or treatment plans will always be given where cases of in-hospital treatment, emergency care, surgery, or hospitalization occurs.

A deposit of 50% of the high-end of the diagnostic or treatment plan before treatment may be required.

Signature- verifies that you accept that payment is due at the time services are rendered.

At ACTS Veterinary Care, we are committed to providing a positive and safe environment for our clients, staff, and animal patients. To ensure a harmonious and respectful atmosphere, we kindly request your cooperation with the following behavior tolerance guidelines:

1. We expect all owners to communicate with our staff in a respectful and courteous manner. Verbal abuse, offensive language, or any form of disrespectful behavior will not be tolerated.

2. While we understand that pet health concerns can be emotional, we request owners to manage and express their emotions in a constructive manner. Uncontrolled emotional outbursts may disrupt the clinic environment.

3. Owners are expected to follow instructions provided by our veterinary professionals. Non-compliance or interference with the treatment process may compromise the well-being of the animal patient and disrupt the efficiency of our services.

4. Owners must adhere to safety measures and regulations within the clinic premises. This includes refraining from disruptive or unsafe actions that may jeopardize the well-being of others.

5. Owners are required to be sober and in a coherent state when attending appointments. We reserve the right to refuse service if an owner appears to be under the influence of alcohol or substances that may impair judgment.

We appreciate your understanding and collaboration in maintaining a positive and conducive environment for the well-being of all. Thank you for entrusting us with the care of your pets.

Signature- I recognize that any aggressive or hostile conduct will lead to the dismissal of my pet from the facility. I am aware that carrying a weapon on clinic premises is not allowed. I understand that I will be denied an appointment on any day when I arrive at my pet's appointment under the influence of alcohol.

Online Pharmacy Policy

At ACTS Veterinary Care we pride ourselves in providing the best quality service for our patients. For us to provide quality care to our patients and due to previous miscommunication, wrong medications being filled, and duplicated prescription requests from external online pharmacies we do not have accounts with Major Corporate Pharmacies like Chewy, 1-800-PetMeds, or any other external Online pharmacy.

**ACTS Veterinary Care WILL NOT approve scripts over the phone, online, or via email for these pharmacies.

At ACTS Veterinary Care we understand that cost can be a contributing factor in deciding where to fill medications. Written prescriptions are available for those clients who wish to fill medications at outside pharmacies like Chewy or Pet Meds. It is the client’s responsibility to send in the prescription to the correct pharmacy for these prescriptions to be filled.

**ACTS Veterinary Care does have an Online Pharmacy that is comparable in price with other external online pharmacies. Please ask for more information if you would like to fill your prescriptions from our online pharmacy. ACTS Veterinary Care also partners with Purina Vet Direct for direct ordering from Purina for Recommended Food.

Thank you for Submitting your information. We look forward to seeing you at your appointment.