New Client Form

Owner Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

How did you hear about us?

Drove By
Google
Facebook
Yelp
Other
Referral

If other, please explain how you found us!

If you were referred by someone, who should we thank?

Secondary Owner

First

Last

Phone

Pet's Name *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Previous Vet Hospital (if applicable)

Allergies/Conditions

Current Medications (Including Heartworm and Flea prevention)

Signature

Clear Signature

Message

Office Visit Form

Thank you for entrusting your pet's care to us today! The following information will be used to help our veterinary team accurately complete your pet's medical history for today's visit. We will need to be able to contact you or someone with permission to make medical and financial decisions.

COVID Protocol Update: Appointments can either be Curbside or if you wish to be in person at the exam a mask must be worn whenever interacting with our team members. Thank you for helping us to keep each other safe.

Do you want to continue Curbside care or do you wish to be present in the exam room? *

In-person visit
Curbside/please call

Curbside/DayAdmission (if you are unable to wait in the parking lot for the duration of your visit)-Vaccines Required to stay:

Dogs: Rabies, Canine Distemper, and Bordetella
Cats: Rabies, Feline Distemper

Client's Name *

Who should we contact to make medical and financial decisions today? *

Owner (named above)
Someone else (named below)

Someone else *

Best Number to Call *

Has your contact information changed? *

Please update if it has changed *

Pet's Name *

Would you allow VANCREST to use photos of your pet for advertising, promotions, or social media? *

Please complete the following information about your pet's health.

What is the reason for today's visit? *

How long has the issue been going on? *

Has it gotten any better, worse, no change? *

Has there been any changes to the pet’s environment or diet recently? *

If yes, please describe the change.

Have you done anything at home? *

Has this ever been a problem in the past? *

If so, when and how was it treated. Did it help?

Please list any medications/supplements/prescription diets your pet is currently on:

Thank you! Be sure to click "Apply Signature" before clicking submit.

Signature

Clear Signature

Thank you! Be sure to click complete your signature before clicking submit.

Your Printed Name *

Medical Progress Form

Do you want to continue Curbside care or do you wish to be present in the exam room? *

In-person visit
Curbside/please call

Curbside/DayAdmission (if you are unable to wait in the parking lot for the duration of your visit)-Vaccines Required to stay:

Dogs: Rabies, Canine Distemper, and Bordetella
Cats: Rabies, Feline Distemper

Client's Name *

Who should we contact to make medical and financial decisions today? *

Owner (named above)
Someone else (named below)

Someone else *

Best Number to Call *

Has your contact information changed? *

Please update if it has changed *

Pet's Name *

Would you allow VANCREST to use photos of your pet for advertising, promotions, or social media? *

Please complete the following information about your pet's health.

How has your pet been doing since their last visit?

Better
Worse (Please elaborate)
No change noted at home

Worse (Please elaborate)

If applicable, have you been giving medications as prescribed?

Are there any new concerns for the following

Coughing
Sneezing
Vomiting
Diarrhea
Weight Gain
Weight loss
Itching/Scratching
Shaking head
Lumps/Bumps
Eating(increased or decreased)
Scooting
Urination issues
Behavioral Problem
Drinking(increased or decreased)
Car sickness
Limping
Other

Other

If there are concerns, how long has your pet been experiencing this problem and provide any additional information concerning the symptoms

Do you need a refill on any Heartworm/Flea/Tick, food or other medicine?

Would you like us to trim the nails today? *

Yes: Toe Nail Trim
Yes: Toe Nail trim with Additional Pedi-paw: files nails smooth
No

Any other concerns or questions to address with the doctor? *

1st Puppy/Kitten Visit Form

Do you want to continue Curbside care or do you wish to be present in the exam room? *

In-person visit
Curbside/please call

Curbside/DayAdmission (if you are unable to wait in the parking lot for the duration of your visit)-Vaccines Required to stay:

Dogs: Rabies, Canine Distemper, and Bordetella
Cats: Rabies, Feline Distemper

Client's Name *

Who should we contact to make medical and financial decisions today? *

Owner (named above)
Someone else (named below)

Someone else *

Best Number to Call *

Has your contact information changed? *

Please update if it has changed *

Pet's Name *

Species *

Breed *

Color *

Age *

Sex *

Would you allow VANCREST to use photos of your pet for advertising, promotions, or social media? *

Please complete the following information about your pet's health.

Where was the puppy/kitten obtained? *

Breeder
Shelter
Pet Store
Other

If other, please specify *

How long have you owned the puppy/kitten? *

Where will the puppy/kitten stay? *

Indoors only
Indoors/outdoors
Outdoors only
Other

If other, please specify *

When outdoors, is your pet..... *

Loose
Leashed
Fenced
Other

If other, please specify *

You have your pet primarily for? *

Companion
Breeding
Show

What brand of food are you feeding? *

Type of food *

Wet
Dry
Both

How much do you feed *

Free fed (food is offered always/whenever hungry)
Measured amount

Have any previous vaccines been administered? *

If yes: dates

Have any previous deworming meds been given? *

If yes: dates

Have any other previous medications been administered? *

If yes: Medication and dates

What does the stool look like *

Normal, formed stools
Mushy diarrhea

Any signs of illness? *

Coughing
Sneezing
Vomiting
Diarrhea
Eating
Drinking
None

Has your pet ever had any adverse reactions to medications or vaccinations? *

Any other animals in the home? *

Dogs
Cats

Any itching, scooting, licking, or biting of paws? *

Dogs
Cats

Would you like us to trim the nails today? *

Toe Nail Trim
Toe Nail trim with Additional Pedi-paw: files nails smooth
No

Any other concerns or questions for the doctor? *

Signature *

Clear Signature

Thank you! Be sure to complete your signature before clicking submit.

Your Printed Name *

New Client Form

Office Visit Form

Please complete the following information about your pet's health.

Medical Progress Form

Please complete the following information about your pet's health.

1st Puppy/Kitten Visit Form

Please complete the following information about your pet's health.

2nd Puppy/Kitten Visit Form

We're Excited to Meet You

Say Hello!

vancrest@vancrestonline.com

803-794-6550

1817 Augusta Rd, West Columbia, SC 29169

Monday, Wednesday, and Friday 7:30-1 PM and 2 pm to 6 pm

Contact Us