Patient forms – Kent Farms Animal Hospital

New Client Information
Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Secondary Number*
Contact Email*
Preferred Method of Contact
- Phone
- Text
- Email
This will be used for updates on visit and vaccination reminders.
Your pet’s appointment and service reminders are notified via text message and email if you provide us this information. Please enter the preferred reminder contacts below. Please list only one of each.
How did you hear about us?
Do you share ownership of your pets with another person?
Co-Owners Name:
Phone
Secondary Number
Email
Preferred Method of Contact
- Phone
- Text
- Email
This will be used for updates on visit and vaccination reminders.
Your pet’s appointment and service reminders are notified via text message and email if you provide us this information. Please enter the preferred reminder contacts below. Please list only one of each.
Payment Policy
Questions and concerns will be handled by our team of highly qualiﬁed and knowledgeable client service representatives, veterinary technicians, and resort staff. All team members should be treated with the same respect as that provided to our doctors. Advice or information relayed by any of our team members has been authorized to be given by a doctor.

Party Responsible for Payment:
Signature
Date
Telephone Consumer Protection Act (TCPA): You agree, in order for us to service your account or to collect monies you may owe, Kent Farms Animal Hospital, and/or our agents, may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or emails, using any email address you provide to use. Methods of contact may include using pre-recorded/artificial voice messages and/or use of automatic dialing device, as applicable. I/we have read this disclosure and agree that Kent Farms Animal Hospital, its employees and/or agents may contact me/us as described above.

Responsible Party Signature
Pet Photo Release
I grant to Kent Farms Animal Hospital, its representatives, and employees the right to take photographs of my pet, to copyright, use and publish the same in print and/or electronically. I agree that Kent Farms Animal Hospital may use such photographs of my pet for any lawful purpose including (but not limited to) purposes such as publicity, illustration, education, advertising, and Web content.

Party Responsible for Payment:
Signature
Date
Client Rights and Responsibilities
As a client, you have the right to…
• Accurate, clear, and impartial information regarding your pet’s health • Receive full explanations about our decisions • Know your pet’s diagnosis, prognosis, and treatment options, including the risks and benefits, based on our capabilities and resources • Be informed of the costs of service we provide in advance of them being performed • Participate in decisions regarding your pet’s care, including declining treatment options presented • Share your questions, concerns, thoughts, or wishes and have them heard by our team • Considerate, respectful, and compassionate care and communication from our team • A fair and objective review of any complaint or problem • Assurance that your personal and medical information is handled in a confidential and private manner • Receive communication regarding any anticipated delays related to your appointment or follow-ups
As a client, you are responsible to…
• Disclose relevant, accurate, and complete medical and behavior history to our team, including previous medical records • Maintain a respectful and considerate demeanor when communicating with any member of our team • Share questions or concerns about anything we’ve discussed or left unaddressed • Honor your financial obligations and payment policies agreed to when your pet receives care • Work collaboratively with your pet’s care team to develop and perform the agreed-upon treatment plan, including any necessary follow-up visits and at-home care • Be aware of the consequences for actions or behavior inconsistent with this document, including potential termination of the veterinary-client-patient relationship
Medical Records and a Veterinary Client Patient Relationship
In order to provide care for your pet we must establish a veterinary-client-patient relationship. We need proof that your pet has been physically examined within the past 365 days. This is important to note when requesting refills of prescription medication or food. We cannot provide these services if we do not have proof of an exam. You are entitled to a complete and thorough copy of your pet’s medical records at any time, including transferring them to a third party for adoption of new pets, housing verification, or scheduling of lodging, daycare, training, or veterinary medical specialist appointments. Pet records will be transferred by your request by the next business day. Record transfer requests may only be made by the listed agent(s) on the account. Upon termination of a veterinary-client-patient relationship, we will transfer pets’ records to a veterinary facility of your choice.
Mutual Respect Policy
Questions and concerns will be handled by our team of highly qualiﬁed and knowledgeable client service representatives, veterinary technicians, and resort staff. All team members should be treated with the same respect as that provided to our doctors. Advice or information relayed by any of our team members has been authorized to be given by a doctor. I have read, understand, and agree to the Client Rights and Responsibilities, Medical Records and a Veterinary Client Patient Relationship, and the Mutual Respect Policy.
Signature

I have read, understand, and agree to the Client Rights and Responsibilities, Medical Records and a Veterinary Client Patient Relationship, and the Mutual Respect Policy.
Date
Pet Information
Name*
Species*
Birthday/Age*
Breed*
Color*
Sex*
Spayed or Neutered?*
Previous Veterinary Clinic (Okay To Contact?)*
Pet Information
Name*
Species*
Birthday/Age*
Breed*
Color*
Sex*
Spayed or Neutered?*
Previous Veterinary Clinic (Okay To Contact?)*
Pet Information
Name*
Species*
Birthday/Age*
Breed*
Color*
Sex*
Spayed or Neutered?*
Previous Veterinary Clinic (Okay To Contact?)*

Anesthesia Release Form
I authorize Kent Farms Animal Hospital to perform such diagnostics, therapeutic and surgical procedures described to me by staff on {PATIENT_NAME}. The nature of such services has been described to me to my satisfaction, and I understand there is an inherent risk of complications, including death. I authorize the clinic staff in an emergency situation, to follow through with such procedures as are necessary for the well-being of {PATIENT_NAME} on a continuing basis until further communication with me. I understand that I assume financial responsibility for all services rendered and agree to pay them in full at the time of discharge.

Client Signature
Date
Please list any medications your pet is currently taking.
Last time the patient had any food or water?
Has the patient ever had a seizure?
Has the patient ever had any preanesthetic complications? If so, explain:
Does the patient need any vaccinations while here?
Pain medication is provided for every patient as needed. Although pain, suffering, and stress are certainly not identical in humans and animals, there is sound documentation that pain increases patient risk during anesthesia. Pain exaggerates the inflammatory response, produces a catabolic state and suppresses the immune system. This delays the wound healing process and predisposes your pet to infections. I understand the cost is anywhere from $36.50-$75.00.

Please Initial
Every surgery patient is required to go home with an E-Collar which we will have fitted to your pet while they are here. I understand the cost will be anywhere from $11- $20 depending on the size they need.

Please Initial
The Rabies Vaccination will be given to any pet that is not currently not up to date, per the law of Alabama. The cost of this vaccination is $ 44.

Please Initial
Intravenous fluids given during surgery help maintain normal blood pressure and allow rapid administration of drugs should an emergency situation develop. For this reason, we recommend IV fluids administration at an additional cost of $37.80. Are you ok with adding this service on?

Yes or No
Abnormalities of the liver, kidneys, or blood may increase anesthetic risk. Blood tests can also diagnose underlying health problems that may lead us to alter or avoid anesthetic protocols. For these reasons we highly recommend pre-anesthetic blood screens on our patients at the cost of $124.00.

Yes or No
CATS ONLY: A Pro BNP test is recommended for all cats before undergoing anesthesia. This will check the function of the heart to make sure he/she does not have an underlying health condition anesthesia could complicate. The cost of this test is $59. Would you like us to check your cat’s heart today?

Yes or No
Laser Therapy is used to help speed healing time, and reduce inflammation. The laser will be used after the incision is closed. The cost of Laser Therapy is $19. Would you like us to laser your pet’s incision today?

Yes or No
Inserting a microchip can be painful while awake. Would you like us to insert a microchip while your pet is sedated for the additional cost of $59.48?

Yes or No
Best contact person while my pet is under anesthesia?
Phone
Home/Work Phone
Client Signature
Date:

Sedation Release
I authorize Kent Farms Animal Hospital to perform such diagnostics, therapeutic and surgical procedures described to me by staff.

Signature
The nature of such services has been described to me to my satisfaction, and I understand there is an inherent risk of complications, including death. I authorize the clinic staff in an emergency situation, to follow through with such procedures as are necessary for the well-being of ________________________________ on a continuing basis until further communication with me. I understand that I assume financial responsibility for all services rendered and agree to pay them in full at the time of discharge.

Signature
Date
Please list any medications your pet is currently taking.
Last time the patient had any food or water?
Has the patient ever had a seizure?
Has patient ever had any complications with sedation? If so, explain:
Does the patient need any vaccinations while here?
Laser Therapy is used to help speed healing time, and reduce inflammation. The laser will be used after the incision is closed. The cost of Laser Therapy is $19. Would you like us to laser your pet’s incision today?

Yes or No
Inserting a microchip can be painful while awake. Would you like us to insert a microchip while your pet is sedated for the additional cost of $59.48?

Yes or No
Any other treatment your pet may need while sedated?

Yes or No
Best contact person while my pet is under anesthesia?
Phone
Home/Work Phone
Client Signature
Date:

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What We Accept

Payment Options

We happily accept Cash, Check, Visa, MC, AMEX, Discover, Scratchpay and CareCredit.

New Client Information

Do you share ownership of your pets with another person?

Payment Policy

Pet Photo Release

Client Rights and Responsibilities

As a client, you have the right to…

As a client, you are responsible to…

Medical Records and a Veterinary Client Patient Relationship

Mutual Respect Policy

Pet Information

Pet Information

Pet Information

Boarding Consent Form

Bark 'N Stretch Questionnaire

Pet Behavior Profile

Does your dog have problems in the following areas?

Daycare Rules, Regulations, and Waiver:

Anesthesia Release Form

Bath Authorization Form

Additional Services

I understand my pet must be current on distemper parvo, lepto, rabies, brodetella, and infulenza (first and second)

I understand matted pets will not be bathed due to medical precautions

I understand that fractious pets may require sedation and/or calming medications, and will not be bathed without approval

I understand if I am unreachable, my pet may not be bathed due to any reason listed above

Sedation Release

What We Accept

Payment Options

Contact Us

Location

Call or text us

Office Hours

DR Appointments