Red Sage Vets- New Patient Information

New Patient Information

Use the form below to tell us more about you and your pet. This will be submitted to our team and we'll be in touch with you during normal business hours in the next 1-2 days.

**This form works best on laptop or desktop- do not use a mobile device to fill out.**

Patient Info:

Scheduling Preferences (because our schedule books in advance, we cannot guarantee availability but will do our best):

Who can we thank for you finding Red Sage?

Is there a Red Sage practitioner you know or prefer to work with? Or first available?

Are you comfortable with your pet's picture or story being shared with others via social media?

Why are you interested in Red Sage Integrative Veterinary Partners?

What is the primary concern/injury/issue you are seeking treatment for at Red Sage?

What diagnostics or work-up (x-rays, blood work, MRI, etc) have been done related to this or similar issues? Where were these performed?

How long has your pet been dealing with this condition? Is the condition getting better, worse or stable?

Can you describe a little more about how the condition began and its progression?

What interventions have been helpful in treating this condition? What interventions have been unhelpful or minimally helpful in treating this condition?

How painful do you perceive your pet’s condition to be? (1 being pain-free and 10 being the most severe pain) What are the signs of pain that your pet shows? (E.g. limping, yelping, difficulty rising, difficulty getting around)

Has your pet experienced any previous health issues?

What is your pet’s current activity level and how has this condition impacted that activity?

How has this condition impacted your pet’s overall quality of life? (E.g. mood, playfulness, sleep patterns, appetite, interaction with your family)

Please provide a detailed list of your pet’s medications and supplements, including frequency and dosing. (E.g. Rimadyl 50 mg twice daily for the last 2 months)

Please provide a detailed list of your pet’s diet and food intake. (E.g. Nulo Front Runner Small Breed ¾ cups twice daily topped with green beans, dried liver treats and a rawhide chew twice weekly)

Considering your pet’s current quality of life and activity, are there specific goals, short-term and long-term, you would like to achieve in addition to pain management (which is a goal for all our patients)?

In human medicine, Patient-Centered Care is a model in which the patient (or in this case, you the pet’s person) has an important role in guiding the framework of therapy. This is the way we practice at Red Sage, we truly see it as a partnership with you and your pet. It is important for us to know what your vision for medical care is, so that we can make a plan that will work best for your family.

Often our treatment plans include some home care- how much time per week do you have to work with your pet?

The finances of veterinary care can often be a source of stress for pet owners. This is an aspect of care that we like to discuss openly and address very transparently at Red Sage. Does budget play a significant role in your treatment decisions and if so, do you have a weekly or monthly budget to help us with treatment planning?

Are there specific therapies within the realm of what Red Sage offers that interest you in particular?

Our collaboration with you will be key to developing an excellent plan for your pet, but it is helpful for us to know ahead of time how boldly you would like to pursue diagnostic tests and treatments for your pet. This does not necessarily mean aggressive or invasive treatments, but the speed and thoroughness of the treatment plan- in other words, the step-by-step approach or the kitchen sink approach. This combined with the goals listed above, and our evaluation, will help us come up with the most compatible treatment plan for your family.

With this in mind what would you like us to know about your desires for treatment?

Is there anything else you would like us to know about your pet? (E.g. allergies, fears, loves/preferences, commands, etc.)

Red Sage strives to offer quantitative measures of patient progress. To aid in this, please fill out the following survey for your pet to give us an idea of your pet's current status.

Rate your dog's attitude and/or mood: 0 (very alert), 1 (alert), 2 (neither alert nor disinterested), 4 (disinterested), 5 (very disinterested/lethargic)

Rate your dog's willingness to participate in play or interact: 0 (very willing), 1 (willing), 2 (reluctant), 3 (very reluctant), 4 (does not participate or interact at all)

Rate your dog's frequency in vocalization or discomfort behavior (audible whining, grunting, yelping, or unusual licking): 0 (never), 1 (hardly ever), 2 (sometimes), 3 (often), 4 (very often)

Rate your dog's eagerness to walk: 0 (very eager), 1 (eager), 2 (reluctant), 3 (very reluctant), 4 (does not want to walk at all)

Rate your dog's ability and/or willingness to walk up or down stairs: 0 (very willing/able), 1 (willing/able), 2 (reluctant), 3 (very reluctant), 4 (does not do stairs at all)

Rate your dog's ability and/or willingness to jump (onto bed, couch, vehicle, etc): 0 (very willing/able), 1 (willing/able), 2 (reluctant), 3 (very reluctant), 4 (does not jump at all)

Rate your dog's ability and/or willingness to run: 0 (very wiling/able), 1 (willing/able), 2 (reluctant), 3 (very reluctant), 4 (does not run at all)

Rate your dog's ease in lying down: 0 (very easy), 1 (easy), 2 (neither easy nor difficult), 3 (difficult), 4 (very difficult)

Rate your dog's rising from a down position: 0 (very easy), 1 (easy), 2 (neither easy nor difficult), 3 (difficult), 4 (very difficult)

Rate your dog's ease of movement after a long rest: 0 (very easy), 1 (easy), 2 (neither easy nor difficult), 3 (difficult), 4 (very difficult)

Rate your dog's ease of movement during and/or after exercise/walks (tired, dragging feet, scruffing nails, lying down): 0 (very easy), 1 (easy), 2 (neither easy nor difficult), 3 (difficult), 4 (very difficult)

Please add any notes or comments regarding your pet's pain survey here:

Thank you for the information, we look forward to seeing you soon! Please help us request related records from other veterinarians, including any labwork or x-rays done in recent months & years!

New Patient Information

Thank you for the information, we look forward to seeing you soon! Please help us request related records from other veterinarians, including any labwork or x-rays done in recent months & years!

REDSAGEVETS@GMAIL.COM
INTERNALMEDICINE@REDSAGEVETS.COM
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1006 Luke street, fort collins co, 80524

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