Physical Exam (Brief Example)

New Patient Form

Welcome to Family Tree Animal Clinic: Your Neighborhood Veterinarian in Milton, GA!

We would love to hear more about you and your companion. Please know that completion of this form doesn’t confirm your appointment time and/or day.

For the most user friendly experience please use a Google Chrome browser to fill out this form. May not be compatible with Apple Mac computers. Please contact us at (770) 450-8880 with any questions/concerns filling out the form below.

Your First Name (required)

Your Last Name (required)

Your Phone Number (required)

Your Email (required)

What is the date of your pet’s appointment? *Please call to schedule the appointment before completing this form. We can be reached at (770) 450-8880.*

What time is your companion’s appointment?*

How did you hear about FTAC?*

Who can we thank for referring you to us?

Secondary Name*

Secondary Phone

Home Address*

Country*

I would like to receive my companion’s vaccine and service reminders via:*

Companion’s Name*

Gender*

Is your companion spayed or neutered?*

Companion’s Age?*

Species*

Breed*

Color*

Markings

Is your pet up to date on vaccines (including Rabies)? Medical records are required to confirm vaccination status.

Any known drug allergies or medical problems?*

Additional Companions? If so, please list the names of the companions who will also be visiting FTAC. Please provide: 1) Name 2) Canine or Feline 3) Age 4) Breed 5) Gender 6) Spayed or Neutered and 7) Color?

After your companions first visit at FTAC you will receive an email at the address listed above from VetScene communications to activate your pet’s account. With this communication tool you will have the availability to view your pet’s medical/vaccine history, request prescription refills, request appointments, and more. In addition you will have the opportunity to opt-in to text messaging reminders.

Please let us know should you have any questions.

I authorize FTAC to use photography and/or video of myself and/or my pet for use on their social media sites and website for marketing purposes. *

I authorize FTAC to share my pet(s) medical records with other veterinary hospitals including emergency facilities, veterinary specialists, boarding facilities, and grooming facilities.*

I would like to have a Free 30 day trial of Trupanion pet insurance sent to my email address listed above. *

I certify that all information on this form is complete and accurate to the best of my knowledge, and I release FTAC of any liability arising in whole or in part from any information that is not correct. Typing your name in the space below constitutes an electronic signature*

*** We accept Visa, Mastercard, American Express, Discover, cash, check, and Care Credit. Payment is due at time of services rendered; please consult with our Guest Ambassador prior to treatment if you have any questions or concerns regarding payment. ***

Hours

Mon, Wed, Fri:

8:00am – 5:00pm

Tues and Thurs:

8:00am - 1:00pm

Every Other Saturday:

9am – 1pm

Location

New Patient

Physical Exam (Brief Example)

New Patient Form

Welcome to Family Tree Animal Clinic: Your Neighborhood Veterinarian in Milton, GA!

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