New Patient Form

Please fill out this form for each of your individual pets.

New Patient Form

  • As the owner or authorized agent of the pet described above, I hereby authorize Dr. Kimberly Curtis and staff of Handle With Care Home Veterinary Service, PC to perform the services I request, and all other procedures, diagnostics, treatments, and/or administration of prescription medications and over the counter medications/supplements (both label and off-label) within accepted veterinary guidelines as deemed advisable and/or necessary for my pet(s). Dr. Curtis and staff will take every reasonable action to ensure the success of my pet’s treatment/procedure, but the possibility of death as a severe complication of any procedure does exist. There is no guarantee, nor can one be made as to the results or cure of any therapy. I agree to pay, in full, for any and all services rendered at the point of service. I understand and agree to the terms of Handle With Care Home Vet’s cancellation policy.

    • Pet's Medical History

  • What follows are guidelines for creating a summary of your pet’s medical history. While I will also want to review relevant medical records from veterinary providers, I am as much interested in YOUR viewpoint.
  • Please provide vaccination history for last 5 years:
 

Verification