Questions about forms…

  • CURRENT PATIENT INTAKE FORM – Do we need this form at all?  The reason I ask is because if you’re sending forms through Ally DVM, then all this information will be populated anyway.
  • Does the AGREEMENT TO TRANSFER form still need Employer information? 
  •  Standard Form template below …
    • Please verify the header information and format and let us know of any changes including more fields that need to be added.
    • Please verify the CPR Directive section and let us know if there are any changes to verbiage or options.
      • Does the question about eating after 10 PM need to be in the CPR Directive section?

Basic Form – Header and DNR Section

Client Information

Address

Patient Information

Is your pet spayed/neutered?
MM slash DD slash YYYY

Start with the bracketed "p"

Use the bracketed "br/" for two line breaks

List items

  1. "ol" means ordered list
  2. "ul" means unordered list
  3. List Item 1
  4. List Item 2
  5. List Item 3


"strong" will bold words

"u" will underline words

Last information listed and end with a "/p" tag!

Cardiopulmonary Resuscitation (CPR) Directive

I understand Veterinary Specialists of the Rockies (VSR) requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of VSR will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400.

I am the owner / agent of this pet and I ...

Signature Section

This field is for validation purposes and should be left unchanged.