We can’t wait to meet you! New Client Pet Comfort Form Welcome to Noah's Ark Veterinary & Boarding Resort. We are so pleased to have your family join ours! Please complete this form so that we may become better acquainted with and help you provide the best possible life for your pet. Step 1 of 4 25% Client InformationOwner's Information* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Contact Number*Secondary Contact NumberEmail* Co-Owner's Full Name First Last Primary Contact NumberSecondary Contact NumberEmail How did you hear about us?* Friend/Family/Coworker Google Social Media Ad Newspaper Ad Magazine Ad Other Who may we thank for the referral? Pet InformationName* Species* Breed* Birthdate* Color* Sex* Female Male Neutered/Spayed?* Yes No Vaccine/Medication Allergies?** Yes No *Please list hereChronic Illness(es)?** Yes No *Please list hereWe care about your pet's comfort and safety.Please answer the questions below so that we can help you and your pet have a comfortable and fear free visit.How would you describe your pet's reaction to going to the vet?* Eager & Excited Subdued Reluctant Somewhere inbetween Please check any situations listed below that your pet has shown avoidance or dislike of in the past.*You may add additional comments at the end. Getting in their carrier or the car Entering the veterinary hospital Other pets and/or people passing by while in reception/check-in Waiting with other people and animals in the waiting area Being approached by veterinary staff Getting on the scale for a weight Hearing the doorbell, overhead intercom, or phones ringing Sounds coming from the back areas of the practice Going into the exam room Being put up on the table for examination Having direct eye contact with the technician and/or veterinarian Loud voices during examination Having a rectal temperature taken The use of instruments such as the stethoscope or otoscope (to look in the ears) Being taken out of the room for procedures Additional comments:*How and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)*How does your pet behave in the car?*Does your pet show any signs of nausea with car travel such as drooling or vomiting?* Drooling Vomiting Drooling & Vomiting No signs How would you describe your pet's behavior around other animals and people?*Does your pet have any sensitive areas that he/she does not like to have touched or examined by you or others?*Are there any proceedures your pet has not liked having performed at the vet in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw?) If so, how did your pet react?*What are your pet's favorite treats? (Please bring some to your visit!)*Does your pet like to play with toys? If so, what kinds?*Has your pet ever been prescribed medications to help with a visit to the vet? If so, please list below*Is there anything else you would like us to know to help make your pet as comfortable as possible?*Do you have another pet you'd like to tell us about?* Yes No Name* Species* Breed* Birthdate Color* Sex* Female Male Neutered/Spayed?* Yes No Vaccine/Medication Allergies?** Yes No *Please list hereChronic Illness(es)?** Yes No *Please list hereHow would you describe your pet's reaction to going to the vet?* Eager & Excited Subdued Reluctant Somewhere inbetween Untitled*Getting in their carrier or the carEntering the veterinary hospitalOther pets and/or people passing by while in reception/check-inWaiting with other people and animals in the waiting areaBeing approached by veterinary staffGetting on the scale for a weightHearing the doorbell, overhead intercom, or phones ringingSounds coming from the back areas of the practiceGoing into the exam roomBeing put up on the table for examinationHaving direct eye contact with the technician and/or veterinarianLoud voices during examinationHaving a rectal temperature takenThe use of instruments such as the stethoscope or otoscope (to look in the ears)Being taken out of the room for proceduresHow and where does your pet travel in the car? (carrier, seatbelt, loose, etc.)*How does your pet behave in the car?*Does your pet show any signs of nausea with car travel such as drooling or vomiting?* Drooling Vomiting Drooling & Vomiting No signs How would you describe your pet's behavior around other animals and people?Does your pet have any sensitive areas that he/she does not like to have touched or examined by your or others?*Do you have another pet you'd like to tell us about?* Yes No Name* Species* Breed* Birthdate Color* Sex* Female Male Neutered/Spayed?* Yes No Vaccine/Medication Allergies?** Yes No *Please list hereChronic Illness(es)?** Yes No *Please list hereHow would you describe your pet's reaction to going to the vet?* Eager & Excited Subdued Reluctant Somewhere inbetween Please check any situations listed below that your pet has shown avoidance or dislike of in the past.*You can add additional comments at the end.Getting in their carrier or the carEntering the veterinary hospitalOther pets and/or people passing by while in reception/check-inWaiting with other people and animals in the waiting areaBeing approached by veterinary staffGetting on the scale for a weightHearing the doorbell, overhead intercom, or phones ringingSounds coming from the back areas of the practiceGoing into the exam roomBeing put up on the table for examinationHaving direct eye contact with the technician and/or veterinarianLoud voices during examinationHaving a rectal temperature takenThe use of instruments such as the stethoscope or otoscope (to look in the ears)Being taken out of the room for proceduresHow and where does your pet travel in the car? (carrier, seatbelt, loose. etc.)*How does your pet behave in the car?*Untitled* Drooling Vomiting Drooling & Vomiting No signs How would you describe your pet's behavior around other animals and people?*Does your pet have any sensitive areas that he/she does not like to have touched or examined by your or others?*Are there any proceedures you pet has not liked having performed at the vet in the past or that seemed difficult for you or the staff to do? (nail trims, weight, temperature, ear exam, blood draw?) If so, how did your pet react?*What are your pet's favorite treats? (Please bring them with you to your visit!)*Does your pet like to play with toys? If so, what kinds?*Has your pet ever been prescribed medications to help with a visit to the vet? If so, please list below.*Anything else you'd like us to know?*Pet RecordsIf you have your pet's records, please upload them here. If you have multiple pets, please be sure they are all included. Max. file size: 256 MB. Is Your Pet Camera Ready?*We love to show off your pets! Do we have permission to use your pet's photos on our social media pages, website and other publications? Yes No Can We Share Your Pet's Records?If your pet ever needs a veterinary specialist, they sometimes request medical records. Do we have permission to provide them if requested? Yes No Payment InformationAll fees are due at the time services are rendered. Estimates will gladly be provided upon request. We accept all major credit cards, cash, Care Credit, and checks (there is a service charge for returned checks).Cancellation PolicyWhen a patient cancels without giving enough notice, they prevent another patient from being seen. It is very important that you arrive on time to ensure that each pet and owner receives the time and care that they deserve. Those arriving late will be asked to reschedule their appointment(s). Please call us at 410-969-0100 ext. 3 by 1pm on the day prior to your scheduled appointment to notify us of any changes or cancellations. To cancel a Monday appointment, please call our office by 12 PM the Saturday prior. If proper notification is not given, you will be charged $25 per missed appointment.By signing below you consent to these terms:SignatureCommentsThis field is for validation purposes and should be left unchanged.
