Red Sage Vets- New Patient Information

New Patient Information

Please fill out the below information so that we can get to know you and your pet a little bit better before you come in! This will allow us to get you into our computer system ahead of time so we have more time to spend with you! We will receive it electronically and include it in your record with us!

**Please note this form does not work well on a phone or tablet and does work well on a laptop or desk top, if this is a problem, please let us know and we can e-mail you the form.***

Owner's Name *

Email *

Address:

Phone No.

How would you like to receive reminders and other information from us- e-mail/text/print/mail:

What clinic or clinics can we contact to get appropriate related records/medical history for your pet (your regular veterinarian or any specialty clinic you have visited):

Where should we send copies of your records- typically your regular veterinarian:

Pet's Name and breed:

Pet's Age/Date of Birth

Male or Female? Spayed or Neutered?

Reason for seeking integrative medicine treatment and or diagnosis:

Primary symptoms/concerns at this time:

Goals for Treatment:

Additional Medical History:

Current Medications and/or Supplements (doses and frequency would be great!):

Current Food and amount Fed:

Normal Activities for Your Pet:

Would you like to be included in a closed facebook group just for our clients to share stories, offer support, and share information about changes or events?:

Is there a general time or day that works well for you to schedule appointments?

Anything else we should know about you and you pet? Food allergies, fears, favorites things, etc.

Dr. Lindsey Fry

Dr. Jessica Rychel

Dr. Jeret benson

dr. lauren prause

New Patient Information

Get back to being a dog (or cat)!

email us at: redsagevets@gmail.com

Dr. Lindsey Fry

Dr. Jessica Rychel

Dr. Jeret benson

dr. lauren prause

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