Holistic Pet Care New Patient Form

Pet's Information

Media Consent

At Mountain View Animal Hospital and Holistic Pet Care, we LOVE to share our patient's cute faces! We try to photograph their success stories, "spa days", playtime in boarding or daycare, and really any moment we can capture that expresses that love! In addition, we add your pet's picture to their medical profile for safety and identification purposes. With this, we require authorization.

I hereby grant Mountain View Animal Hospital and Holistic Pet Care permission to use any photographs taken of my pet in all its publications, including website and social media entries. I understand this is voluntary and I am aware I will receive no compensation. I understand and agree that these materials will become property of the hospital. I hereby release the hospital and its employees from any claims, demands, and causes to action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or the behalf of my estate, have or may have by reason of this authorization.

Release of Liability for Holding

Our staff is trained to physically manage, hold, or otherwise restrain your pet in the safest and most comfortable way. Should you decide that you wish to assist during exams or procedures, our staff and hospital shall not be held liable for any injury that may arise, whether it be done to or by your pet.

I have read and understand the release of liability for holding my pet and the media consent form and have been given opportunity to ask any questions.

Holistic Chinese Diagnostic History Form

Welcome to our Holistic Clinic! Please take several minutes to fill out this form. This detailed history helps our holistic doctors establish a Holistic medical diagnosis, aiding in our treatment and herbal recommendations. We encourage you to fill this form out anytime you feel there are major changes in your pets history. You may ask for this form at any of your recheck examinations.

Please Check off All that Apply:

Please check any Chronic Problems your pet has / is suffering from:

Five Element Quiz

The 5 elements are an old philosophy used to describe interactions and relationships between personality, health, and predispositions to common ailments. Once a holistic veterinarian has reviewed your pet and this quiz, they will supply you with the information of your pet's element.