Administrative Hours: 8:30 am - 6:30 pm, Wednesday - Saturday | 6225 42nd Ave. N., Minneapolis, MN 55422
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Registration: Follow Up Clinic
PLEASE FILL OUT THE FOLLOWING TO COMPLETE YOUR REGISTRATION
Step
1
of
5
20%
Select a date to begin
(Required)
Client Information and Intake
Please select
I am bringing my own pet
I am bringing a foster pet with a rescue
I am bringing a friend/family member's pet
Rescue Name
(Required)
What is your (the client's) name?
(Required)
First
Last
Pronouns
No Answer Given/Unknown
She/her/hers
Him/he/his
They/them/theirs
Other
Phone Number
(Required)
May we text visit alerts to this number?
(Required)
Yes
No
Street Address
(Required)
City
(Required)
State
(Required)
Zip Code
(Required)
Email
(Required)
Do you have any budget concerns/constraints for this visit?
If you have a specific budget you need to work within (ex. no more than $300), please let us know. We try our best to work within your budget concerns, and can direct you to some great resources for additional help! While we are not a non-profit organization, and do not run on a sliding fee scale or have in house payment plans, we do work with some companies and grant organizations which may facilitate payment plans or even help pay for part of your pet's care. You can find more information on our FAQ page.
Would you like to add a secondary contact to your account?
Yes
No
Secondary Contact (Optional)
Let us know if you'd like to add an additional person to your account! Secondary contacts can be removed by the primary account holder at any time upon request (please contact our administrative team for assistance!).
What is their name?
First
Last
Secondary Contact's Pronouns
No Answer Given/Unknown
She/her/hers
Him/he/his
They/them/theirs
Other
Phone
May we text visit alerts to this number?
Yes
No
Is this person authorized to make medical decisions for your pet?
Yes
No
Let's Get Some Basic Information on Your Pet!
What is your pet's name?
(Required)
Date of Birth (DOB) or Age
(Required)
If indicating age (vs DOB), please indicate weeks, months, or years. Example: 1 year / 2 months / 5 weeks. If you don't know your pets age, please indicate (to the best of your ability) if they are likely a puppy, young adult, middle age adult, or geriatric adult.
Species
(Required)
Dog
Cat
Other
List Species if Other
(Required)
Breed
(Required)
Breed
(Required)
Breed
(Required)
Domestic Shorthaired Cat
Domestic Mediumhair
Domestic Longhaired Cat
Maine Coon
Munchkin
Persian
Ragamuffin
Ragdoll
Russian Blue
Scottish Fold
Siamese
Unknown/Other
List Breed if Other
Color
(Required)
Sex
(Required)
Male Intact
Male Neutered/Fixed
Female Intact
Female Spayed/Fixed
Unknown
Has your pet had any behavioral issues at prior veterinary visits?
(Required)
Aggression, anxiety, fear, etc.?
Yes
No
What kind of behavioral issues have they displayed?
(Required)
Will your pet be receiving oral sedatives before their visit?
(Required)
We recommend giving your pet oral sedatives 2 hours prior to your appointment time.
Yes
No
Does your pet normally receive injectable sedation at veterinary visits?
(Required)
Yes
No
We often give treats in clinic, including peanut butter. Do you or your pet(s) have any allergies we should be aware of?
Yes
No
Please list any allergens.
Please breifly note your reason for visit. This is just for registration, we'll send a link for an updated history (and treatment consent) closer to your visit, so the veterinarian gets the most up-to-date information as possible.
(Required)
Marketing/Social Media
Yes, Access Veterinary Care may use pictures of my pet, and/or descriptions of their medical history, background, diagnoses, treatments, etc. for marketing or educational purposes.
No, Access Veterinary Care may NOT use pictures of my pet, and/or descriptions of their medical history, background, diagnoses, treatments, etc. for marketing or educational purposes.
Medical Records (Optional)
Consent for Records Release
If your pet's medical records are requested by other clinics, groomers, boarding facilities, animal control, or other 3rd parties, do you authorize Access Veterinary Care to pass along your pets records?
Yes, Access Veterinary Care can send my pets records to any inquiring party
No, please contact me before sending my pets records anywhere
If your pet has been seen at another clinic for this specific concern, please list them below.
Facility Name |
Location |
Phone Number:
Add
Remove
Please upload relevant medical records here. Records can also be sent to info@myaccessvetcare.com if not readily available.
Drop files here or
Select files
Max. file size: 1 GB.
Please keep an eye on your e-mail or text messages!
Your visit reminder will contain an important link:
(Required)
You'll receive a visit reminder a couple days prior to your pets appointment containing a link to your pet's history forms. Please fill these forms out prior to your arrival. Thank you!
I understand that I will need to fill out my pets history and treatment consent form prior to arrival
Name
This field is for validation purposes and should be left unchanged.
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