*Your Cell Phone will be the primary number on your profile.
**We respect your privacy and will never share your information without your consent. We use email as a form of primary communication to relay important information / changes about our hospital while also sharing upcoming promotions and important educational health information. In addition, you may receive your pets healthcare reminders.
Is there anyone else you would like to add to the account that could have access to your pet's healthcare information (family member, pet sitter, etc)?
First and Last Name:
Relationship to you or your pet:
Do you plan to make this practice your primary veterinarian? Yes No
Name and Phone Number (if available) of your pet(s) last visited animal hospital:
How did you hear about us?
Word of Mouth or Existing Client/Employee Name:
It is important to us as an Integrative Animal Hospital to understand how you would like us to discuss healthcare options for your pet. How much of a Holistic (natural) approach do you prefer in your pet’s health?
(1 being the lowest; 4 being the highest): 1 2 3 4
I, the owner of the patient(s), hereby authorize the veterinarians and staff of Mountain View Animal Hospital & Holistic Pet Care to examine, treat, and prescribe the necessary medication for the above-listed pet. This includes but is not limited to, procedures therapeutically and/or diagnostically. I understand that no guarantee of successful treatment is made. I further understand that this facility has a doctor on staff between 7:30 am to 5:30 pm only, therefore, there is no continuous presence of doctors after regular business hours. I certify that all the information above is correct, that I am the rightful owner or authorized agent of this pet(s), and that I am at least 18 years of age. Mountain View Animal Hospital & Holistic Pet Care does not operate as an emergency hospital and although we will always try to be available, I understand I may be referred to an emergency hospital even during open hours if the veterinary staff feel it is in the best interest for my pet(s). I understand by Nevada pharmaceutical law, all prescriptions including herbals that leave the hospital are non-refundable. Payment Policy
Please note: All fees incurred at Mountain View Animal Hospital & Holistic Pet Care are required to be paid upon time of service. We do not accept payment plans or delayed billing. Any unpaid balance left unpaid are subject to accrued 1.5% interest after 30 days, and balances left unpaid for more than 90 days will be sent to collections in addition to a 40% collection fee. There is a $35 charge for each returned check, and we do not accept any postdated checks. We accept Visa, Mastercard, American Express, and CareCredit & for established clients (been here at least 2 times) we also accept checks. Any credits placed on the account must be utilized within 2 years of the date they were added.
I acknowledge that I have read and understand the Payment Policy.
We request that any cancellations be made at least 24 hours prior to the start of your pet's medical appointment or grooming appointment reservation. If you cancel without ample notice or do not show up to your appointment or boarding/daycare reservation you may be required to pay a cancellation fee. This fee is non-refundable and cannot be applied toward any other services.
I acknowledge that I have read and understand the Cancellation Policy.
I have read, understand and accept all the information above.
Pet First Name:
My pet is a: Dog Cat Other:
DOB / Approximate Age:
Color / Distinctive Markings:
My pet is: Female Spayed Male Neutered Female Intact Male Intact
Known Allergies (to medications, food, environment): As a Fear Free Clinic we emphasize lots of cookies at our visits. If your pet has allergies - please let us know and feel free to bring your special treats from home!
Current Diet (check all that apply):
Kibble Canned/Wet Home Cooked Freeze Dried / Dehydrated RAW
Name of Food / Description:
How often do you feed?
Current Medications / Supplements: Please include any preventatives (such as Heartgard) & over-the-counter supplements. If possible, the milligram dosage, dosage frequency, and when the last dosage was given.
Any additional information you would like us to know about your beloved pet:
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", playing with our staff, 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.
In signing this consent, I give authorization of the following (check any that apply!):
The Use of My Pets Photo for Medical Record Identification Purposes ONLY
The Use of My Pets Photo for Medical Record Identification Purposes AND Social Media
The Use of My Photo if I am in the picture with my pet and/or offering to share my experience on social media
I decline all media consent, understanding that declining pictures of my pet in the medical record system may inhibit staff from correctly identifying my pet.
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 the opportunity to ask any questions.
Printed First and Last Name
Holistic and Fear-Free Patient History Form
As an Integrative Animal Hospital, we believe the best medicine has a combination of scientifically proven western treatments combined with Natural (Holistic) treatments. This detailed history helps our Integrative Doctors establish a Holistic Medical Diagnosis and Five Element, aiding in our overall treatment approach and herbal recommendations. We encourage you to fill this form out anytime you feel there are major changes in your pet's history. You may ask for this form at any of your recheck examinations and annual exams!
Please List your Primary Concerns today:
Please Check off All that Apply:
Eater and/or Not Food Motivated
Not a Big Drinker
Bright Red Blood
Incontinent (unable to hold in fecal material) Date it started:
Does not urinate frequently
5. Urine Smell
6. Urine Color
Doesn't vocalize/Hardly Ever
Hyperactive / Overly Exuberant
Calm / Reserved
10. Hair Coat
Texture or Color Changing
Greasy / Oily
Large Dandruff Flakes Small Dandruff Flakes
12. Temperature Preference
Loves Cool / Shade / Laying on Cool Floors
Either / Neutral
13. Surface Preference
Soft Surfaces / Bedding
14. Stiffness, if present is WORSE after:
15. Stiffness, if present is BETTER after:
Please check any Chronic Problems your pet has/is suffering from:
Chronic Ear Infections
Excessively Wet / Abnormal Drooling
Excessively Wet / Abnormal Drooling
Dry / Cracked Nose or Skin Above Nose
Sneezing / Reverse Sneezing
Vomits Whole Food
In general, do you feel your pet smells? If so, how would you describe it?
Rancid Scorched Fragrant Rotten Putrid Other:
We LOVE our Clients and Patients!
Dear Valued Client, due to the recent surge in pet adoptions, staffing shortages, and population growth, the veterinary industry is managing scheduling challenges nationwide. For clear communication and a mutually rewarding relationship, we ask that you please read and check the box indicating that you've been notified, agree, and understand. Thank you!
Our intent is to provide excellent client and patient service. We are a local and family-owned hospital and welcome your feedback. If you feel we have not met your 5 Star Expecations, we would love the opportunity to improve. Please ask to speak to one of our supervisors or administration team or contact us at email@example.com.
Our focus is integrative (combined western and natural) medicine for the prevention and treatment of illness in a Fear Free facility. At this time, we are not equipped for emergencies. Reno has 24-hour, 365-day emergency hospital options. We would be honored to perform subsequent follow-up treatments and exams after an ER visit. Please inform us if you have visited an ER facility with your pet, as their medical records do not automatically transfer or alert us of your visit. We will need medical records to properly follow up and treat your pet going forward.
We ask that you forward book your pet's future healthcare needs for the entire year! This helps ensure we can accommodate your schedule and prevents last-minute conflicts!
As your "family" vet, we understand that other priorities may come up. We are happy to reschedule your appointment and we want you to be aware that it may take up to 8 weeks before our next opening.
If you're running late, PLEASE call us. After 15 minutes we may need to reschedule your appointment. If we can not reach you after 15 minutes, your appointment will be considered canceled. After 3 canceled or rescheduled appointments, you will be required to pre-pay a non-refundable deposit before your next appointment is scheduled.
If you have additional concerns than originally discussed when scheduling, please let us know with as much time in advance of your appointment. This allows us time to rearrange our schedule to allow your concerns to be addressed. Additional concerns may require diagnostic resources and staff that may be otherwise unavailable based on your original appointment.
If you feel that your pet needs urgent care, please call us. We always try to accommodate your needs. Please understand we maintain excellent patient care for all, prioritizing those we have already committed to. We have a limited number of patients we can safely see in a day based on considerations such as staffing and facility space.
The bottom of your invoice lists all future appointments, upcoming recommended pet health reminders (and their due dates), and home care information. You can also find future appointments and your pets' health reminders on our suggested Smart App, “Pet Desk.”
[For Holistic Clients Only] We are not equipped for emergency services in our Holistic Referral Center. If your pet needs urgent care, we may refer you to the Mountain View side of our hospital or an emergency hospital.
[For Holistic Clients Only] If you feel your pet needs to come in for more frequent holistic treatments, please let us know as soon as possible so we can do our best to adjust your appointments.
I have read and acknowledged the statements above.
Five Element Quiz
Traditional Chinese Veterinary Medicine (TCVM) uses a system of classification called the 5 elements. The 5 elements apply to personality, disease predisposition patterns, and dietary considerations. This article will help you understand the primary elemental personality type of your dog, and feed accordingly.
Loves to be Pet
Center of the Party
Obeys the Rules
Fire personality animals are very jovial and love life. They are the type of dog that is going to be bursting with happiness to see you and possibly try to give you as many kisses as you will allow in greeting. Fire animals also tend to be very vocal often expressing themselves with a wide variety of sounds, besides the typical bark. These animals love attention and want to be the star of the show. These animals will strive to do what their people ask of them as they love the reward. Fire dogs are often considered hyper.
Earth personalities are very friendly and loving dogs, but also are okay with time to themselves. They are nurturers and like to care for others. They generally have a happy, laid-back personality and are up for whatever their people feel like doing. Earth personalities tend to be slower moving, and often need more sleep than other personalities. Earth tends to think a lot about how to take care of their owners or others in the household and this makes them prone to the emotion of worry which can lead to gastrointestinal upset. However, Earth personalities tend to have longer life spans!
Wood personality animals are generally very confident animals. This is a dog that is not usually afraid of anything and may charge right up to you in greeting or sit next to their owner barking a warning. However, they are often very friendly with people they know, you just have to be approved first. These dogs are very loyal and want to please their owners. They are very driven to win.
Water personality animals tend to be very quiet and reserved. They are the most introverted of personalities and tend to be more independent and solitary, even when in familiar surroundings. Like the Metal personality, Water likes to analyze the situation before acting. Water types are prone to the emotion of fear. These dogs are hesitant and tend to look to their owners for guidance in new situations. Most water animals prefer to hide or run but will bite or scratch if unable to avoid unwanted interactions / perceived danger.
Metal personalities tend to be leaders due to their confidence and consistency. They are quiet and independent, seeming aloof, but they like to analyze the situation before getting involved. They are not unfriendly, just reserved. Metal personalities enjoy rules and order and like to have a job and a set procedure for their daily routines. This dog will expect you to also follow a schedule and will let you know if you are late feeding them or when it is time to go for their walk. They are driven to succeed and will not pay attention to anyone or anything at a dog park or when someone comes over to the home if they have a job to do.
I understand all of the information above and I agree that the information that I have filled out is correct.
Printed First and Last Name