NEW CLIENT FORM

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

NEW CLIENT FORM

We are currently taking new commercial dairy, commercial beef, commercial sheep, and commercial goat clients! If your farm falls into one of these categories, we will be happy to take care of your horses, pigs, and donkeys too!

Thank you for the opportunity to care for your livestock. Please complete this form prior to your first appointment. We look forward to serving you! -Dr. Jake & Taunya
(540) 299-COWS // rrsvetoffice@gmail.com // www.rrsvet.com

Email *

First and Last Name *

Full Farm Address(es) *

Full Mailing Address (if different) *

Phone Number *

Is anyone else authorized to make appointments for your animals? Please list full name(s).

Who can we thank for referring you? *

Farm Species (please select all that apply) *

Beef

Dairy

Equine

Sheep

Goats

Swine

Other:

Required

If individual animal(s) are to be seen, please list their name, date of birth, breed, and sex.

PAYMENT POLICY: Payment is due when services are rendered before we leave your farm. WE DO NOT BILL. We accept cash, card, or check. If you prefer to pay with card, we ask that a card be put on file with us prior to your first appointment. By choosing an option below, you are agreeing that you understand this policy. Please note that boarding facility clients are required to keep a card on file. *

I will pay by cash or check when Dr. Jake comes to my farm.

I prefer to pay by card and will call prior to my first appointment to put a card on file.

Other RRS Policies & Information

PAPERLESS: In an effort to improve efficiency and reduce waste, our business is paperless. All invoices, receipts, and records will be sent to the email you provide. If you do not receive an email shortly after your appointment, please check your spam folder or contact us to ensure delivery. Paper copies are available upon request.

HOURS: Our business hours are 8am-5pm Monday-Friday. We also offer after-hour emergency services for our current clients. A current client means we have been on your farm doing routine work within the past year.

AFTER HOURS EMERGENCIES: If you have an emergency after hours, please call (540) 299-COWS to leave a message on our emergency line and Dr. Jake will call you back as soon as he is available. Please note that texts and Facebook messages are not monitored after hours. Please call for emergencies so we can best serve you.

SCHEDULING: We schedule routine appointments based on location and vocational urgency. Please call as soon as possible to schedule routine work so we can be sure to provide the best possible appointment time for you. Please note that as a one-vet practice, there may be times when Dr. Jake is unavailable or unable to get to your farm in a timely manner for an emergency. He tries his absolute best to get where he is needed, but as a practice we also advocate having certain medications on hand for your herd in the instance Dr. Jake can talk you through treatment for common ailments over the phone.

PRESCRIPTION MEDICATION: We strive to make ordering prescription medicine easy for our clients. We have an online store with a selection of common medications that you can shop at your convenience. You can also give our office a call to order medication to be picked up at our drop box in Floyd or delivered directly to your home.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms