Client Profile

Create or Update Your Client Profile

Exotic Pet Vets provides a full range of veterinary and boarding services to all kinds of exotic pets. We treat and board small mammals, fish, reptiles, amphibians, birds, and more.

If this is an emergency, please instead call the closest location listed above.

Si se trata de una emergencia, por favor llame a la ubicación más cercana de las que se enumeran arriba.

Please note you must be 18 years or older to fill out this form, and to make medical and financial decisions for a pet. We request that all pets be brought in an appropriate carrier to our hospitals. Also, do not bring additional pets or dogs to your appointment.

We look forward to meeting your exotic friends.

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Name *

First

Last

Exotic Pet Vets Location

Please choose the preferred location you will be bringing the patient to

Location For Visit *

I have already scheduled an appointment *

Owner Information

How do you prefer to be addressed?

Your Pronouns

Other Pronoun

Email *

We will not disclose your email address to anyone! This is only so we can reach you about your pet.

Home Phone *

Work Phone

Cell Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employer

Student, active military or over 65?

Please show your ID to the receptionist to receive a 10% discount.

Your Birthday *

You must be at least 18 years old to complete this form.

Others authorized for account

Name of others authorized *

First

Last

Do Spayed/Neutered? addressed?

Phone number for others authorized

Tell Us About Your Pet

Patient Name *

Age (Y/M) *

Species/Breed *

Sex *

Spayed/Neutered? *

Major colors *

Add Another Pet

If you have another pet you'd like us to care for, tell us here.

Additional Patient Name

Age (Y/M)

Species/Breed

Sex

Spayed/Neutered?

Additional Pet's Major colors *

Other veterinarian info

Do you have another veterinarian? If so, who?

Do you want to inform this vet about today's visit?

How did you hear about us?

Select and describe all that apply!

Friend

Pet Store

Veterinarian reference (if different than above)

Internet

Google search
Social Media
Bing/Yahoo search
Linked from another site
Other

Hospital Disclosures

Please read and initial the following statements. Our staff will be happy to explain any of these statements prior to your initialing.

I authorize and direct the veterinarians at Exotic Pet Vets to examine, diagnose, and prescribe as they deem necessary for the patient’s well-being. No warranty or guarantee has been made as to the result or cure. ALL FEES ARE REQUIRED TO BE PAID IN FULL UPON COMPLETION OF THE VISIT. We accept cash, Visa, Mastercard, AMEX, Discover, CareCredit, and Cherry. A deposit may be required at the time of admission and the balance paid in full at discharge. If you have any questions about the fees or policies, please alert us prior to services being performed. Accounts not paid within 30 days are subject to an interest finance charge. In the event any balance due is not paid as agreed, the undersigned jointly and severally agrees to pay all costs included in the unpaid balance, including reasonable collection and/or attorneys’ fees.

Authorization to pay *

Credit Card Policy
I authorize Exotic Pet Vets to keep my credit card information securely on-file in my account. I authorize Exotic Pet Vets to charge my credit card for any services rendered at the time of appointment.

Credit Card Policy Agreement *

I Agree
I Disagree

I understand that my pet may act differently than it does at home & there is a chance it may bite, scratch, or otherwise attempt to injure anyone, including myself, while handling it. I understand that I should not handle my pet during any procedures and that if I do this waives liability of the hospital if I am injured directly or indirectly by the actions of my pet during said procedures.

Restraint of Patient *

I understand that there are few medications specifically licensed for use in exotic pets. I authorize the extra label use of medications on my pets and I understand the potential risks associated with such treatment.

Extra Label Use of Drugs *

I understand that in the event of a life-threatening emergency, Exotic Pet Vets may initiate stabilization efforts, including CPR, as medically appropriate. I understand that CPR and emergency stabilization may result in additional charges, and that specific CPR/DNR decisions will be reviewed and authorized on applicable treatment estimates and emergency consent forms.

Stabilization Efforts *

Exotic Pet Vets is not 24-hour facilities, and personnel will not tend to patients beyond regular office hours. I understand that I can request transfer to an emergency veterinary hospital with 24-hour care if overnight hospitalization is required

No Overnight Staff *

Exotic Pet Vets may want to use pictures/and or information resulting from the veterinary care of my pet on their website, social media sites, or for other educational purposes. Only the pet’s first name & medical condition will be used. Client name, address & other personal information will NOT be used. I understand that if I choose to revoke this permission, I must notify the hospital in writing.

Photo or Medical Case Release *

I DO NOT AGREE
I AGREE

To help our veterinary team maintain accurate records, we may use AI-assisted recording during your pet's exam. If you prefer this not be used during your visit, please let our staff know before the exam begins

AI-Assisted Medical Documentation *

I understand AI-assisted recording may be used during my pet's exam and know I can opt out by informing staff beforehand.

I understand that I should be 15 minutes early to my appointment to allow adequate check in time. If I am late to my appointment, I may be asked to reschedule. If my pet needs to be worked into the schedule, there will be a late fee associated with this.

Check In Time *

Masks are currently not required. I understand that if I feel ill or have a fever, I will reschedule my appointment.

COVID-19 Mask Policy *

Deposit Policy

I understand that I will be required to pay a $50 deposit fee when scheduling an appointment. The deposit fee will be applied towards the amount due from the services provided to the patient during the appointment. I understand that if I need to cancel/reschedule the appointment and do not provide a 24-hour notice, I forfeit the $50 deposit.

Deposit Policy

I understand that I will be required to pay a $70 deposit fee when scheduling an appointment. The deposit fee will be applied towards the amount due from the services provided to the patient during the appointment. I understand that if I need to cancel/reschedule the appointment and do not provide a 24-hour notice, I forfeit the $70 deposit.

I understand the Deposit Policy *

Signature

Clear Signature

By signing your name here, you agree this will be used as your signature and you agree to all the terms above. Please ensure your signature is legible on screen! We may ask you to sign again in person at the office if it isn't.