Owner Information

Authorized contacts will have permission to make medical decisions and have full access to the account.

Primary Owner

Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Email(Required)

Enter Email Confirm Email

Secondary Owner

Name

First Last

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone Number

Enter Email Confirm Email

Emergency Contact (In the event that the primary and secondary contacts cannot be reached)

Name

First Last

Phone

**Do you authorize this person to make medical decisions about your pet(s)?

Yes

Patient Information

Pet #1

Pet #1 Name(Required)

Pet #1 Age(Required)

Pet #1 Species(Required)

Pet #1 Breed/Color(Required)

Pet #1 Sex(Required)

Male

Male Neutered

Female

Female Spayed

Pet #1 Doesn't Like

Loud noises

Nail trims

Other animals

Separation from owner

Car rides

Other

List other things Pet #1 doesn't like(Required)

Pet #2

Pet #2 Name

Pet #2 Age

Pet #2 Species

Pet #2 Breed/Color

Pet #2 Sex

Male

Male Neutered

Female

Female Spayed

Pet #2 Doesn't Like

Loud noises

Nail trims

Other animals

Separation from owner

Car rides

Other

List other things Pet #1 doesn't like

Referral Information

How did you hear about us?

If referred by a client, please provide name and phone

Financial Policy Statement

CareVet of Fort Thomas requires payment in full at the end of your pet's examination or services.

We accept the following payment methods:

Cash
Major credit cards including: Visa®, MasterCard®, American Express® or Discover Card®
Care Credit® Healthcare Credit Card(For more information ask our Customer care representatives, who can assist with the application process)
Check

There is a 2.5% processing fee for using a credit card. There is no charge for paying by debit card, cash, check, or Care Credit.

Please provide information below regarding the party who is financially responsible for the pet(s) on this account:

Name(Required)

First Last

Phone(Required)

Email(Required)

By signing below, you certify that the information above is correct, and that you understand and agree with the policy listed above

Signature(Required)

Date(Required)

Record Release Authorization

I, the owner or agent of the pet(s) listed above, authorize the release of my pet’s medical records to the following:

Veterinary Offices
Boarding Facilities
Daycare Facilities
Grooming Facilities
Shelters and Rescues (In the event I am applying to adopt or foster a pet)

I understand that I may revoke this authorization at any time by contacting CareVet of Fort Thomas.

I, the owner or agent of the pet(s) listed above, authorize the release of my pet’s medical records to the entities listed above.(Required)

I authorize

I do not authorize

Signature of Owner(Required)

Date(Required)

Social Media Consent

CareVet of Fort Thomas occasionally utilizes various modes of social media (Facebook, Tiktok, Instagram, Twitter, etc.) to connect with our clients. Only your pet’s name, photograph, and possibly brief information (medical, breed, pet of the week, etc.) are used. No client information is used unless we receive specific permission from you.

I understand that I may revoke this authorization at any time by contacting CareVet of Fort Thomas at (859) 781-7387 or by email at fortthomas@carevethealth.com

Social Media Authorization(Required)

I authorize my pet’s information to be used

I do NOT authorize my pet’s information to be used

Signature of Owner(Required)

Date(Required)

AI-powered transcription consent

Our practice has implemented AI-powered transcription software to securely capture audio during appointments and follow-up communications. This technology allows our team to spend less time focused on computer screens and more time engaging directly with our patients and clients.

By enabling our veterinarians to efficiently summarize conversations and document key details, this system helps us improve accuracy, streamline communication, and remain readily available to assist you in a timely manner

By signing below, you consent to the use of AI-powered transcription technology to record and document my visit/session, as well as follow up communication, for the purpose of creating accurate medical records.

Signature of Owner(Required)

Date(Required)

A copy of this signed form will be saved with your records.

I understand that I may revoke this authorization at any time by contacting CareVet of Fort Thomas at (859) 781-7387 or by email at fortthomas@carevethealth.com

CAPTCHA

New Client Form

Owner Information

Patient Information

Referral Information

Financial Policy Statement

Record Release Authorization

Social Media Consent

AI-powered transcription consent

Expert Veterinary Care in Fort Thomas, KY