New Client Appointment Request"*" indicates required fields Step 1 of 333%Why Choose Us? Our mission is to provide your pet with a calming environment where the highest quality medical care and customer service are provided by compassionate and knowledgeable staff. The doctors and staff at West Villages Animal Clinic aim to exceed your expectations and will treat every pet like one of our own. We understand the special bond you have with your pet is unlike any other. We are here to help you fully understand your pet’s healthcare needs so your pet can live its best life. Our practice philosophy is that an ounce of prevention is worth a pound of cure. State-of-the-art medical care will be provided following evidence-based medicine and research, with the most up-to-date equipment available. We wish to be in a mutually exclusive partnership with you, in order to provide a lifelong relationship with your pet. This relationship must be built on open communication, mutual respect, honesty, and trust from both parties in following medical recommendations. During your visits, expect to be greeted by a courteous receptionist, clean exam rooms, friendly veterinarians, and caring technicians/assistants. Our team members all have extensive veterinary experience (on average, over 14 years each) and all attend frequent continuing education with the common goal to follow the most recent medical guidelines. Appointments are not rushed, and ample time is spent getting to know you and your pet(s). Our focus is to provide preventative care, advanced care for illness, chronic disease management, dentistry, and soft tissue surgeries. While we do provide vaccinations for our patients, we are NOT a vaccination clinic. Preventative care is defined as a thorough annual wellness examination and consultation, annual comprehensive lab work (CBC, chemistry, urinalysis, heartworm, tick screening), monthly parasitic presentation, frequent dental prophylactic care, referrals to veterinary specialists when indicated, and a customized vaccination plan based on lifestyle. If this sounds like a good fit for your family, please answer the questions below for our review. Upon review, if it seems like our goals are similar to your expectations, we will reach out to schedule an appointment. Please provide as much detail as possible for the following questions:What are your healthcare goals and expectations for your pet(s)?*Rank the following in order of importance with (1) being most important and (5) least important to you.Pricing*Proximity*Availability*Mutual trust/exclusive relationship*Recommendations to provide the highest standard of quality care*When your pet(s) are sick, what are your expectations for care?*List your pet’s heartworm and flea/tick prevention and frequency of administration. If not on prevention, share the reasons why.*Do you have Pet Insurance? If so, with what company.*Has your pet had an anesthetic dental procedure? If yes, how was the experience? If no, why not?*What are your feelings on veterinary technicians communicating and answering medical questions directly to you on behalf of the veterinarian’s recommendations that you may have for your pet(s)*While we schedule on an appointment basis, we strive to be available for our patients during urgent care or emergency illnesses. If your pet encounters an emergency, beyond a physical examination, diagnostic testing is almost always fundamental in determining the severity of an illness, a treatment plan as well as a prognosis. The medical recommendations and prices will be explained and provided at every visit. If your pet has urgent health concerns that require immediate care, are you comfortable discussing your expectations and financial concerns openly and honestly with our team?* Yes No **Please forward medical records from all previous veterinarians immediately to email@example.com. Thank you for your time and consideration in allowing West Villages Animal Clinic to become a partner for your family’s veterinary care. We will review all information and based on your responses, we will reach out to you to schedule an initial examination and consultation.Please tell us how you chose our clinic:* I was referred by __________ Website/Facebook/Instagram page Previously a client of Dr. Daniels Location/Drive-byI was referred by:*Owner InformationOwner Name*Spouse/Partner NamePrimary Phone*Secondary PhoneEmail Address*Local Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Permanent Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer*Job Title*Pet Information*NameDate of BirthSpeciesBreedColorSexMicrochip#Spayed or Neutered Add RemovePrevious VeterinarianPhone NumberDo you consent that we contact your previous veterinarian to obtain medical records?* Yes NoCommunication PreferencesWhat is your preferred method of communication from us?* Text Email Call MailDo you agree to receive text message communications from us?* Yes NoDo you agree to receive email communications from us?* Yes NoDo give permission to use photographs or videos of your pets in social media?* Yes No Return policy: Over-the-counter, unopened, non-perishable merchandise may be returned within 14 calendar days with an original receipt. Prescription medication is legally prohibited from being resold in the state of Florida. Therefore, all prescription medication is non-refundable. Financial Policy: Payment is due at the Ame services are rendered. An estimate (verbal or written) will be provided prior to service. The bill may be more or less than estimated due to unforeseen factors or changes in the patient’s condition. I agree to pay the final bill, in full, at the Ame services are rendered. West Villages Animal Clinic does not accept checks. We do accept Cash, Visa, Mastercard, Discover, American Express, and Care Credit. I certify that I am the owner and/or agent of the above animal and have the authorization to consent to treatment if and when it is needed.Date* MM slash DD slash YYYY Signature*Printed Name* Food and Medication InformationOwner's NamePet's NameDate MM slash DD slash YYYY Your pet’s dietary and nutritional information is a vital part of their medical history. An accurate and thorough dietary history is needed for our medical staff to provide recommendations during times of healthy maintenance and is essential for accurately diagnosing and treating your pet in times of illness. For any diet, food or treat that has been started recently (within the last 30 days), please indicate with an “ * ” symbol. Food Information Please list all food and treats you feed to your pet on a regular basis. For dry food, a “cup” refers to a standard 8 ounce cup. Please specify if a larger cup is used and provide the estimated volume.FoodBrand of food(s)Dry or canned foodAmount fed, in cups or can, per feedingMeals per day? Add RemoveHuman Food (table scraps, vegetables, fruit, etc.)Type of food(s)Amount givenHow many times per day? Add RemoveTreatsBrand of treat(s)How many given per day? Add Remove Medication Information A detailed record of your pet’s prescribed and over-the-counter medications is essential for our medical staff. Our staff will use this information to help guide any needed medical therapies to ensure that no drug interactions exist between medications that your pet may already be taking and medications that your pet may need to receive in the future. Please list all medications (prescribed by us or any veterinarian) and dietary supplements (ie.: glucosamine/chondroitin, Omega 3 or fish oils, vitamins, etc.)Prescribed Medications (prescribed by a veterinarian)Medication NameStrength (mg)Amount Given (# pills, mL)Number of times given per day Add RemoveDietary supplements (glucosamine/chondroitin, Omega 3 or fish oils, vitamins, etc)Supplement NameStrength/size (If applicable)Amount per day Add RemoveHeartworm, flea and tick preventionBrand NameNumber of times given per monthDay of month last given Add Remove Prescription Policy West Villages Animal Clinic has a fully stocked pharmacy, plus several online trusted pharmacies. Our online pharmacies include Pro Plan Vet Direct, Hills to Home, VRS Health, and VetSource. The links to these pharmacy options can be found in the upper left corner of our website homepage. All prescriptions purchased from our pharmacies are FULLY manufacturer-warranted and guaranteed. We make every effort to price our prescription products competitively, and often for less after rebates and specials than many online pharmacies. We are aware of the many options available for pet prescriptions. In the event you wish to purchase from a third-party pharmacy, we ask that you read our pharmacy policy. We will provide a written prescription upon request, provided that we have recently examined your pet, that its required tests are current, and that the particular medication or product requested is appropriate based on the weight and health of the animal. The timeframe of "recent examination" and "current" test is at the doctor's discretion but will never exceed more than one year from your pet's last annual examination and last negative/normal test. The written prescription will be provided directly to you within 1-2 business days of your request. You may request to pick it up directly from the clinic or ask to have it mailed to your home address. We do not charge a fee for writing prescriptions for our patients. If you would like the written prescription mailed to your home address, there is a $5 shipping & handling fee. Prescriptions will be available for pick-up at our office during regular business hours, within two business days of your request. If you choose to use the internet or outside pharmacy to obtain your pet's medications, you should mail the original written prescription to the pharmacy. We do not respond to fax, email or telephone calls requesting prescription authorizations from any online or outside pharmacies. Special security features of our written prescriptions prevent any attempt to fax, copy or scan them by causing "VOID" to appear across the copied prescription, thus invalidating it. Carefully select your outside pharmacy. Unfortunately, due to unethical practices and consistent medication errors made at several online/outside pharmacies, West Villages Animal Clinic has created this policy. The purpose of this policy is to ensure the health and safety of your pet and thus will not be deviated away from under any circumstances.SignatureDate MM slash DD slash YYYY Printed NameNameThis field is for validation purposes and should be left unchanged.