Just Cats Veterinary Services

1015 Evergreen Circle
The Woodlands, TX 77380

(281)367-2287

www.justcatsvets.com

Patient History Form for Technician Appointments

***At this time we are only seeing curbside and drop off appointments***

Please fill out the name, phone number, and email address of the person we will be contacting during the appointment time.  It is imperative that you be available to discuss and approve/decline treatments while your cat is in our care.

The patient history form is required for all office visits. 

Tech Appt Patient History Form

Client Name (required)

Cell Phone Number (required)

E-Mail Address (required)

Make, Model, and Color of the vehicle you will be arriving in (required)

Patient Name (required)

Current Medications - Please include ALL medications your pet is currently taking or has recently taken
Please list as medication name, dosage, directions for use, and when it was last given (Ex: Cerenia 16mg - 1/2 tab every 48 hours - Last Given: 1/2/18 at 3pm) (required)

Do you have any concerns with your kitty at this time? (required)

Curbside/Drop Off Consent
I am the owner or agent of the cat named above and have the authority to execute this consent. I understand that during the performance of procedure(s)/operation(s), unforeseen conditions may be revealed that necessitates an extension of the foregoing procedure(s)/operation(s) or different procedure(s)/operation(s) than those provided in the treatment plan. I hereby consent to authorize the performance of such procedure(s)/operation(s) as are necessary and desirable in exercise of the veterinarian's judgement. I have been advised as to the nature of the procedure(s)/ operation(s) and the risks involved. I realize that the results cannot be guaranteed. I also authorize the use of appropriate anesthetics, and other medications, and I understand that hospital support personnel will be employed as deemed necessary by the veterinarian. To prevent the spread of infectious disease, any cat with fleas will be treated with an oral and/or topical medication upon admission to the hospital. The price of the treatment will be added to your invoice. I have read and understand this authorization and consent. By submitting this form I hereby consent and authorize the performance of the procedures that I have approved in the treatment plan. I agree to pay all charges incurred when my cat is released from the hospital.
Please initial below if you have read the above and authorize the performance of the estimated treatments/procedures (required)


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1015 Evergreen Circle
The Woodlands, TX 77380

P: (281) 367-2287
F: (281) 367-0700 

vets@justcatsvets.com

Hours of Operation:
Monday-Friday: 7am-6pm
Saturday & Sunday: Closed 

 

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