I am excited to meet you and your furry friend.

PRICING

Fill out the intake form to begin the process. Upon reviewing your intake form, I will contact you to schedule your initial consultation.

Please review my service boundaries prior to filling out the intake form. If you are near the boundaries feel free to contact me to verify one way or the other.

a map showing the service area of monroe county

CLIENT INTAKE FORM

This form is for pet parents. Please fill out one form for each pet. If you are a referring veterinarian, please either visit this page for more info or refer your patient by using the veterinary referral form.

Client Intake Form

Your First Name*

Your Last Name*

Email*

Phone*

Street Address 1*

Street Address 2

City*

Zip Code*

Pet Name*

Species*

Sex*

Date of Birth*

Breed*

Weight*

Medical Details

Medical Details

Name of Primary Veterinarian

Primary Veterinarian Clinic Name*

Primary Veterinary Clinic Email Address

Expiration date of most recent Rabies Vaccine*

Primary Concern/Duration

Current Medications/Treatments

Current Food and How Much?

Past or Present Medical Conditions

Treatment Goals

Temperature Preferences (Does your pet get hot/cold easily?)

Services you are interested in (ok if no initial preference)

Herbal Medication

Veterinary Acupuncture

Light/Laser Therapy

Anything else you wish to let Dr. Jessi Turner know

How did you hear about Healing Hands Holistic Veterinary Specialties?

Opt-In

I am aware that Dr. Jessi Turner does house calls and as such, she may be running early or late and appointment times are approximate. I will be available at least 30 minutes before and after the appointment time.*

Opt-In

I am aware that Dr. Jessi Turner may have someone shadowing her, as such there may be someone else that comes to my pet's appointment.*

Opt-In

I have reviewed the pricing HERE. *

Opt-In

I am aware that I will need to be present and involved during the appointment to assist with the management of my pet.

If possible, please upload all of your pet's veterinary records here.

Upload File

I am excited to meet you and your furry friend.

CLIENT INTAKE FORM

Client Intake Form

Providing pets with premium Integrative Veterinary Medicine in a loving and thoughtful way so they can live healthy, happy lives.

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