Convenient Client Forms Online

Making things easy gives us more time to give your pet the care they deserve. And it saves you time in the hospital, too! We offer all of our client forms online so you can fill them out on your own time. Click on the appropriate form below, complete it, and click 'submit.'  Please contact us at (770) 717-1650 with any questions.

New Patient Form

New Clients can either complete the form below in its entirety and submit to us electronically, or download the New Patient Form, print and complete and bring with you to your scheduled appointment. 

If you have multiple pets - a New Patient Form needs to be filled out and submitted for each pet. After filling out a form for one pet, click on the "Submit" button and then choose New Patient Form from the menu again and fill out a new form for the next pet. The "Submit" button must be clicked at the end of each pet's form - do not hit the back button.

Are You an Existing Client of The Village Vets?
Have you scheduled an appointment with us already?
Please let us know how you heard about The Village Vets.

Client Information

Name
Name
First
Last
Spouse/Partner/Other Name
Spouse/Partner/Other Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Preferred Contact Method

Pet Information

Spayed or Neutered?
Sex/Gender

Maximum file size: 52.43MB

Pets are required to be current on vaccinations for boarding and all drop-off procedures. Exams are required for, and are a separate charge with annual vaccinations.
Has your pet ever had an adverse reaction after having vaccines?
I hereby assume full and complete responsibility for the charges that may occur during the examination and/or treatment. I also understand that Payment is due in full on completion of examination or patient discharge. Furthermore, I do understand that if my animal is ill and/or hospitalized, a deposit may be required.

We gladly accept Visa, Mastercard, American Express and Cash.
WE DO NOT ACCEPT PERSONAL CHECKS FROM NEW CLIENTS.

BY SIGNING MY NAME AND DATE HERE I INDICATE THAT I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION.

Client Satisfaction Survey

Use the form key below (1 being worst, 5 being best) to rate your experience with us on a scale of one to five:

  • 1 = Very dissatisfied
  • 2 = Somewhat dissatisfied
  • 3 = Satisfied
  • 4 = More than satisfied
  • 5 = Extremely satisfied
  • N/A = Not Applicable
Please note the practice location.
How did you hear about us?

Telephone service

During your most recent interaction with our hospital, how satisfied were you with each of the following:
The greeting
The amount of time you were put "on hold", if applicable?
If you left a message for a doctor or staff member, the amount of time it took for you to receive a return call?
Appointment and doctor availability?

Appearance

During your most recent interaction with our hospital, how satisfied were you with each of the following:
The general appearance of our doctors and team members (i.e. did they have a professional appearance)?
The general appearance and cleanliness of the hospital interior (i.e. reception area, the exam room, general aroma)?
The general appearance of the hospital exterior (i.e. the building, parking lot, grounds)?

Customer Service

During your most recent interaction with our hospital, how satisfied were you with each of the following:
The greeting you and your pet received upon entering the hospital?
The wait time you experienced in the reception area?
If you did have any wait time in the reception area, were you offered a beverage or refreshment?
The wait time you experienced in the exam room?
The wait time you experienced at check-out?
The accuracy of your bill?

Patient Care

During your most recent interaction with our hospital, how satisfied were you with each of the following:
The way in which our doctors and team interacted with your pet?
The way in which your pet was restrained or held for his/her physical exam?

Medical Care

During your most recent interaction with our hospital, how satisfied were you with each of the following:
The thoroughness of the patient history taken for your pet?
The thoroughness of our doctor's examination of your pet?
The thoroughness and the clarity of our doctor's explanation of your pet's physical condition to you?
The thoroughness and clarity of our doctor's health plan for your pet's visit (i.e. medical recommendations for diagnostic tests and further treatments)?
The thoroughness and clarity of our doctor's and team's instructions for your pet's home care (i.e. cleaning ears, brushing teeth, administering medications)?

Overall Value

During your most recent interaction with our hospital, how satisfied were you with each of the following:
Overall Experience
The quality of care you and your pet received?
The service and care you and your pet received at our hospital in relation to the amount of your bill?
I plan to continue using The Village Vets
I would/will recommend The Village Vets to my friends and family

Thank you for participating in our Client Satisfaction Survey.

  • If you prefer to submit your response anonymously, simply click the "submit" button below.
  • If you do not want to remain anonymous, before clicking "submit", please fill out your name, pet's name and contact information below and let us know if you would like to be contacted in order to follow up on your responses to this survey.
Name
Name
First
Last
Please let us know if you would like to be called to discuss your answers or comments further.

Boarding Release Form
Name
Name
First
Last
For general or emergency contact purposes, please choose the preferred method of contacting you, or an authorized representative, while your pet is boarding.
Boarding reservations are recommended to ensure space is available. Have you already made the boarding reservation?
Is this currently a patient of The Village Vets?
Would you like for your pet to have a bath before he or she is picked up from boarding

Boarding Agreement

Please note: The Village Vets is not responsible for clients/pets personal items (leashes/collars/toys/bedding) that are left  during their pet’s visit.

In case of illness or injury, I, the undersigned, do hereby give my authorization and consent for the doctors of the hospital to treat any illness and/or injury of my pet(s) while they are being boarded at The Village Vets.    I also understand that these services performed on my pet(s) during The Village Vets Decatur’s afterhours will be charged  the same fees as Emergency After-Hours.

They are to use all responsible precautions against illness, injury, or escape of my pet(s), but they will not be held liable or responsible in any manner whatsoever, under any circumstances, on account of the care, treatment, or safe keeping of my pet(s), as it is thoroughly understood that I assume all risks.

Should the circumstances arise that my pet(s) remain unclaimed after the date which I have stated as the pick-up date, I understand that written notice will be mailed to my current address. Seven days after such written notice the pet(s) will be considered abandoned and may be disposed of, or destroyed, as the hospital deems best. It is further understood that such action will not relieve me from paying all costs of the services, including the cost of the boarding service.

The Village Vets  promotes a flea and tick free environment.  If fleas and/or ticks are noted on your pet(s) upon arrival or while here, a preventative will be applied to your pet immediately, and the charge for the preventative will be added to your bill.

My pet has been fully vaccinated within the past 12 months. If I cannot show proof of such vaccinations, then I give permission for the hospital to administer vaccinations required for the boarding of my pet(s).  With annual vaccines your pet will be examined by a veterinarian and subsequent fees will apply.  For cat boarding, a FeLV/FIV test must have been done within the year for outdoor cats and within three years for inside cats.  For dog boarding, a fecal exam must have been done within the year and proof provided, along with proof of vaccines.

I have read and understand the authorization and consent.

Appointment History Form
Name
Name
First
Last

*PLEASE WEAR A FACE COVERING TO YOUR CURBSIDE APPT AND STAY IN VEHICLE*

What is your reason for pet’s appt today:
If vaccines are due would you prefer a 1 year or 3 year protocol?
Vomiting?
Diarrhea?
Coughing?
Coughing - If yes, does anything come up?
Sneezing?
If yes, any discharge from nose or eyes?
Wheezing?
Radio Buttons
Behavior change/lethargy?
Pain?
Lameness?
Change in appetite?
Change in water intake (drinking)?
Other pets at home?
Is your pet on heartworm/flea/tick preventatives?
FOR CAT OWNERS:
Have you travelled outside GA or been sick / exposed to a sick (respiratory) person in the last 14 days?