Call or Text 972-636-9562 general@cfvc.net

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*We Are Hiring*

Please Note: We will be closed from Saturday, August 30th, through Monday, September 1st, in observance of Labor Day!

Patient Appointment Form

Read our Welcome Letter

Name(Required)

First Last

Please provide the best phone number for your treatment team to reach you for your appointment:(Required)

If this number is different from what we have on record, would you like us to update your primary contact?(Required)

Yes

No

My phone number has not changed.

What is your current primary email address?(Required)

View our CFVC Appointment Courtesy Policy.

Pet’s Name:(Required)

Appointment Date:(Required)

MM slash DD slash YYYY

Please list reasons for your upcoming appointment and include any concerns that you have:(Required)

If my pet is being seen for an annual or semi-annual wellness exam, I need to bring a small poop sample in a baggie or small container to our appointment.(Required)

I understand.

Please provide the following nutritional information:

What brand and type of food does your pet eat (please include how much and how often)?(Required)

How much and how often is your pet given treats and snacks?(Required)

Is your pet currently on any heartworm/flea and tick preventions?(Required)

No, my pet is not on any of the above.

Yes, my pet is on heartworm, flea, and tick prevention.

Other

Please explain “other”:(Required)

Is your pet on any medications and or supplements?(Required)

No

Yes

Please list all current medications and or supplements.(Required)

Please provide an EMERGENCY contact’s name and phone number:

Name(Required)

First Last

Phone(Required)

Which of the following describes you best:(Required)

I am an existing client.

I am an existing client with a new pet(s).

I am new to Country Friends Veterinary Clinic (CFVC) and or I am seeking a second opinion.

Has your new pet had any services such as vaccines, exams, and/or treatment performed somewhere other than CVFC?(Required)

No

Yes

In the past two years, has your pet had any exams, vaccines, and or treatments performed at another veterinary hospital/clinic?(Required)

No

Yes

For CFVC to provide the best care for my pet, I need to provide my pet’s medical records (depending on age, up to 3 years of health history) to Country Friends Veterinary Clinic (CFVC) prior to my pet’s exam. These records may help to avoid repeating any previously performed tests/diagnostics, services/ treatments, and vaccinations with their associated costs.(Required)

I understand.

If I do not provide up to 3 years (depending on age) of previous medical records, the doctors at CFVC will make the best judgement for recommendations/treatment/vaccinations for my pet.(Required)

I understand.

To email CFVC your pet’s records: general@cfvc.net
To FAX CFVC your pet’s records: 972-636-9592

Please provide the following information for our records:

Previous Clinic Name (if unknown put "unknown"):(Required)

Previous Phone Number (if unknown put "unknown"):(Required)

For the safety of all pets, clients, and team members- as well as for the wellbeing of your pet(s), please read and click on all applicable statements.

My pet can be described as:(Required)

Potentially having a contagious disease (symptoms could include diarrhea and or coughing).

Anxious and or fearful.

Animal aggressive.

Has bitten and or has shown aggressive tendencies toward people.

Having the tendency to compulsively bark.

Not being on a leash, nor crated.

None of the above.

If I checked any of the above, I will call or text 972-636-9562 to inform the Country Friends team that my pet(s) and I will wait in our car until a team member communicates that an exam room is ready.(Required)

I understand.

Thank you and see you and your pet(s) very soon!
Your Country Friend’s Treatment Team

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Email

This field is for validation purposes and should be left unchanged.

We are so happy that you have chosen to join the Country Friends family!

Here are a few links that can help you get to know us a little better and help you with future visits:

Our Country Friends website
Meet Our Team
Financial Payment Options
View our Forms page:
- Please fill out our Client Form two days prior to your appointment
- Please fill out our History Form as soon as you make your appointment
- Pet Lodging Form

Please visit our communications app at PetDesk or through your Apple Store or Goole Play. This app includes our loyalty program and other benefits such as scheduling and confirming an appointment, requesting prescription refills, receiving vaccines, and all other reminders. This app will even give you pet insurance quotes and so much more, i.e., it keeps your pet’s records, including visits/labs/and messages! If you have any questions, we are happy to help you get started.

We look forward to continuing to grow our relationship with you and your fur-baby(ies)!

Love,
Your Country Friends Family

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