New Client Information and Consent Form

Please fill out the following information before your appointment with Dr. Lauren. If you have multiple pets, please fill out a new form for each animal.  

Appointments are available during the following times:

Sunday and Monday: Closed

Tuesday through Friday: 11 am to 7 pm

Saturday: 11 am to 3 pm

Payment is expected in full at time of service. Cash, checks, and credit cards accepted.

 

 

Please note: We will be CLOSED from Wednesday, November 21st through Tuesday, November 27th

In order to give all of our patients the care and attention they deserve, we are not currently accepting new clients. Please keep checking back for updates!

**If we have previously seen another animal in your household, please contact us directly to schedule an appointment**

 

To schedule an appointment, please call 520.979.7273, email PricklyPearVet@gmail.com or fill out a Contact Request Form.

 

**Please use the New Client Form below if you have ALREADY set an appointment with Prickly Pear Vet**

New Client Information and Consent Form
First Name*
Last Name*
Address*
City*
State*
Zip*
Email*
Phone*
Primary Veterinary Clinic
Primary Veterinarian
How did you hear about us?
Animal's Name*
Animal's Birthdate (mm/dd/yyyy)*
Species (dog? cat? horse?)*
Breed (Cocker Spaniel? Domestic Short Hair? etc)*
Color*
Sex*
Weight, in pounds (if known)
Please briefly explain your concerns or questions
I read the Consent and Payment Agreement below*
Electronic Signature*
Date*

I, the owner of the pet identified above, consent to the examination and treatment of my pet with acupuncture, and/or chiropractic, and/or herbs by Lauren Genow, DVM of Prickly Pear Holistic Veterinary Care, LLC. Acupuncture, chiropractic, and herbal therapy are considered to be a part of Complementary and Alternative Veterinary Medicine (CAVM). Acupuncture treatment techniques include but are not limited to the following: dry needling, electroacupuncture, aquapuncture, and moxibustion. I understand that complications of acupuncture are uncommon and include, but are not limited to: broken needle under the skin, needle ingestion, infection, and bleeding. Side effects of herbal therapy can include vomiting and diarrhea but these effects are rare and usually mild. I understand and am informed that in the practice of chiropractic therapy there are some risks to treatment, including but not limited to fractures, disc injuries, strokes, dislocations and sprains. I do not expect the veterinarian to be able to anticipate all risks and complications, and I wish to rely upon the veterinarian to exercise judgement during the course of the procedure, in my best interest, based upon the facts then known to her. ***By inputing my Electronic Signature above, I agree to pay any expenses associated with care provided by Prickly Pear Holistic Veterinary Care, LLC.***