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Thank you for scheduling an appointment with Integrative Oncology & Veterinary Wellness! We look forward to becoming part of your pet's healthcare team. Below you will find some helpful information to aid in preparation for your pet's appointment as well as the required documents needed.

Name(Required)
What is your pets breed?
What is your pets breed?
In-Person Appointment Information(Required)
In-Person Appointment Information

- Please arrive 5-10 minutes prior to your scheduled appointment time to ensure an on-time start.
- Our address is: 33 Newman Springs Road, Tinton Falls, NJ 07724. Ample parking is available in an off-street parking lot outside of our practice which is located on the first floor.



Consultation Checklist - Please bring all below items with you to your appointment!

-A list of all questions you have for the Doctor.
-Every client should come prepared with their top goals and questions regarding your pet’s condition, as you will be asked for active participation in ultimately deciding what your pet’s treatment plan is going to look like.
-All supplements and medications for the Doctor to review.
(Physical bottles are necessary to confirm specific details that may not be included on your intake forms, including taste, smell, or ingredients)
-Any additional medical records that may have occurred after the time of scheduling the consultation. Records are requested immediately following consultation scheduling and therefore any visits during the time following scheduling the consultation will not be obtained.
- Your ability to be open-minded and empowered to make the best choices for your pet's treatment plan!
- Your pet!

Clients are kindly requested to provide a minimum of 48 hours notice for any cancellation or rescheduling of appointments. This allows us the opportunity to offer the appointment slot to another client in need of our services.
In the event that a client cancels or reschedules an appointment with less than 48 hours notice, a fee of $60.00 will be incurred. Cancellations within 24 hours will result in a $100.00 fee.

This fee is applicable to all types of appointments offered at Prism excluding consultations.

The cancellation or rescheduling fee will be added to the client's account and must be settled before scheduling any future appointments. Payment can be made in person or over the phone via credit card.

Clients can cancel or reschedule appointments by contacting our office directly during business hours. For after-hours cancellations or emergencies, clients can leave a voicemail message, and our team will address the request as soon as possible.

To help reduce the likelihood of missed appointments, our office sends out appointment reminders via text message prior to the scheduled date. Clients are encouraged to confirm their appointments upon receipt of these reminders.
Clear Signature
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Social Media: I hereby give Prism Integrative Veterinary Health LLC permission to take photographs and videos of myself and my pet for the purpose of Facebook, YouTube, Twitter, Instagram, and the website. My consent is freely given as a public service without expecting payment. I hereby release and discharge Prism Integrative Veterinary Health LLC from any and all claims arising out of the use of the photos. Prism Integrative Veterinary Health has my permission to use:(Required)
Practice Policies
Practice Policies
Business Hours
Mon: 9AM-2PM, Tue: 9AM-5PM, Wed: 9AM-7PM, Thu: 9AM-5PM, Fri: 9AM-5PM. We are closed weekends and major holidays, as well as intermittently during professional development. *Hours are subject to change*

Appointments
Consultation Deposit: I understand that by placing an initial deposit, I am allowing the practice to begin their research and preparation process for my pets case. I understand that this initial deposit is non-refundable.

Cancellations: An advance cancellation policy allows us to accommodate patients with critical needs as well as those receiving routine care. I understand that if I cancel or reschedule an appointment with less than 24 business hours for recheck assessments, I will be charged a fee ($45 for reassessment). I understand that if I fail to call ahead and do not show up for my scheduled appointment, I will be charged a $110 no call/no show fee. I understand that there is a $45 late fee if I show up more than 10 minutes late to my scheduled appointment time. I understand that there is a $45 cancellation fee for cancellations made within 24 business hours of my scheduled appointment time. I also understand that appointment reminders are a courtesy and will be sent by email and text message.

Consultation Rescheduling: Rescheduling for consultations are required to be completed no later than 72 business hours prior to your appointment. In the event that an appointment needs to be rescheduled within 72 business hours of your appointment, a new deposit will be required. I understand that if I do not provide the required notice, I will need to place a new deposit to reschedule my consultation.

***A PHONE CALL IS REQUIRED TO CANCEL, CHANGE OR RESCHEDULE ALL APPOINTMENTS***

*Pricing is subject to change*
*A credit card is required to be stored on file at the time of booking*

Supplements & Products
All supplements and products are available for purchase through our online apothecary: thepetfarmacy.com. For any prescription formulas, your treating veterinarian will be required to complete a prescription authorization.


Returns
Personalized tinctures, creams, herbal formulations and essential oils cannot be returned. Unopened prepackaged containers and standard bulk herbs can be returned for a full refund minus a 10% restocking fee. The cost of return shipping will not be refunded.

Payment
Payment is due at the time that services are rendered. We accept Visa, MasterCard, American Express, Discover, cash, check and Care Credit. There is a $35 processing fee for returned checks. Accounts not paid within 30 days are subject to a 1.5% monthly finance charge.

Services Not Available
Our practice is focused on holistic and integrative treatments. We do not offer surgery, x-rays, ultrasounds, hospitalizations, biopsies, radiation therapy, euthanasia, or emergency care. All patients should maintain their relationship with an emergency hospital in the event these services are needed.

Medical Records
Medical records will be obtained by our staff. At the time of scheduling, please make sure we have information on ALL veterinary practices that have previously evaluated your pet. If we are missing any records 7 days prior to your pet’s appointment, we will reach out to you asking to help in facilitation. Records not received 72 business hours prior to the scheduled appointment will not be reviewed at the time of the appointment.

Email Policy
Email is to be used for office staff communication only. Our Doctors are unable to answer medical questions via email due to the sheer volume of requests as well as the complicated nature of our patients. Any follow-up questions can be performed as additional medical record reviews or through a phone call between our doctors and your veterinarian.

Referrals & Reviews
Your referral is our best compliment! When any new client provides your name at the time of initial consultation, you will be sent a $20 ‘Thank You’ to use on products and services at your next visit!

By signing below, I certify that I have read and received a copy of these practice policies.
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Informed Consent Statement
Informed Consent Statement

Prism Integrative Veterinary Health, LLC, in addition to the use of conventional veterinary treatments, also utilizes treatments that are sometimes classified as alternative, complementary, and/or integrative therapies. These therapies include but are not limited to: herbal and botanical substances, nutritional supplements, IV vitamins, and nutrient therapies, spinal manipulation and acupuncture. Some of these treatment techniques, as employed by Prism Integrative Veterinary Health, LLC, are specifically designed for use in animals that are critically ill, non-responsive to conventional treatments and others have sometimes been deemed as hopeless.



Such alternative and/or integrative treatments are chosen, recommended, and/or administered to an animal when Prism Integrative Veterinary Health, LLC believes that they have the potential to be efficacious in the treatment of an animal’s health problem. However, this is not a guarantee that the chosen medication or treatment will be effective in treating a specific animal’s problem. Additionally, as with all medications and treatments, there is always a chance for potential side effects. While adverse side effects are rare and every effort is made to minimize them, individual animals may not be able to tolerate the prescribed medication and/or treatment.



I acknowledge that I have read the above statement and understand it. As the legal owner and/or responsible agent for the animal described below, I grant you my consent to receive, prescribe for, and/or treat this animal, including the use of modalities and substances which may be considered to be alternative, complementary, and/or integrative. I recognize that recommendations and/or treatments are not guaranteed to cure or improve the health of my animal.



I expect this Practice to use all reasonable precautions against the injury or death of my animal, but I assume all risks associated with the treatment of my pet and release the Practice and officers, directors, affiliates, employees, agents, insurers, and stockholders of the Practice (collectively, the “Releases”) from all liability and waive any and all claims, including but not limited to injury or death to my pet or damage to personal property, against Releases in connection with or arising out of the Practice’s treatment of my pet as described herein.
Clear Signature
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Mutual Respect Agreement(Required)
We want to take this time to remind everyone about our mutual respect policy, which will allow our practice to continue caring for your pet in the highest level possible while also assisting you when making difficult treatment decisions related to your pet’s care. As many of our patients are facing serious life-threatening conditions, we treat every patient and client concern with the upmost priority. In order to effectively answer and respond to all concerns, there are certain protocols that need to be followed to ensure a timely response and fairness to all patients and clients, as well as our staff.

o All voice mail messages will be returned the same day (if received during business hours) or the next business day (if left after business hours).

o Repeated calls cannot be prioritized due to our small staff size. Messages are checked multiple times throughout the day, so please leave a clear and concise message and we will return your call as soon as we are available.

o We do not provide emergency services at our practice. If your pet is facing a life-threatening emergency or you are concerned, please take your pet to the nearest emergency facility or to your primary care veterinarian.

o Refills require 48-72 hours for processing. Please leave ample time (1 week recommended of remaining herbs and supplements) for processing and shipping of supplements. Expedited/overnight shipping cannot be promised or guaranteed.

o All refills are now being processed via our online pharmacy, ThePetFarmacy.com.

o Informing us of all visits with other veterinarians PRIOR to your upcoming appointments will allow us the opportunity to obtain medical records. Even when you are told medical records will be sent, miscommunications can happen. Please confirm WITH OUR PRACTICE that records were received.

o We are always striving to provide you with the compassion, care and attention you and your pet deserve. We will always do our best to assist you and help you in any way we can. Yelling, rude comments, and profanity will not be tolerated. We will always respect you and expect the same respect in return.

o Together, we are all a team, with the most important players being our pet parents. As such, we rely on one another for the success of your pet’s treatment. At the practice we work hard to be organized, timely and conscientious of the energy it takes you to institute an integrative treatment plan. Utilizing notebooks or journals to take notes at each appointment, ensure all questions are answered during appointment times, timely arrivals for appointments, and referring to all paperwork and handouts provided will enhance communication and empower our owners to make the best decisions possible!

o If at any time the practice is not meeting the needs of you or your pet, please do not hesitate to speak with us. Our approach to patient care is very different from traditional veterinary practices and we whole heartedly understand this may not be the best fit for everyone. We will be sure to assist you in finding a holistic practitioner that will be better suited for you and your family, as there are many trusted colleagues we are glad to recommend. We are happy to work together to ensure everyone has what they need to move forward in this journey toward health.

Termination of Services
In the event that either party deems it necessary to end the professional relationship, they reserve the right to do so at any time. Should this occur, efforts will be made to ensure a smooth transition, including appropriate referrals or support as needed.
Clear Signature
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Pet Information and Health History

Thank you for giving us the opportunity to assist in the care of your pet. To ensure the best treatment plan possible, please take the time to fill out this form completely and in detail. This section is the most important and will take the longest to complete. Please plan to spend 20-30 minutes (or more) ensuring all details are complete and accurate as these will go directly into your pet's medical record for the Doctor's review. Please feel free to get a cup of tea and take your time to ensure all information is accurate!

What problem(s) or condition(s) are you interested in developing a treatment plan for? Please list in priority of importance to you. Please provide additional concise details and dates. Ex: Hemangiosarcoma - diagnosed 1/21/20 ; Losing weight - ongoing issue since 2/3/19 ; Fur issues - started 3/2008, resolved 5/2010, started back up 12/2021(Required)
Condition
Diagnoses Date
Details
 
What conventional medications is your pet currently receiving? Please provide medication name, strength, dosage, and intended use of all prescription and over the counter medications, as well as the date they were first given. Ex: Pepcid 20mg, 1 tablet twice daily for acid reflux, started March 2010 ; Deramaxx 100mg, 1 tablet once daily for inflammation, started 1 week ago (Feb 2020)(Required)
Medication
Strength
Dosage
Intended Use
Date Started
 
What supplements, vitamins, herbal formulas, homeopathic remedies, or other natural products is your pet currently receiving? Please provide brand name, strength, dosage, and intended use for all supplements, as well as the date they were first given. Ex: Fish Oil, Nordic Naturals - 1500mg per pump, 2 pumps once daily for joint health, started at 2 yrs old in 2010 ; Wei Qi Booster, Jing Tang Herbals - 500mg per tsp, 2 tsps twice daily for respiratory health, started Jan 2020(Required)
Brand Name
Product Name
Strength
Dosage
Date Started
Intended Use
 
What supplements, vitamins, herbal formulas, homeopathic remedies, or other natural products is your pet currently receiving? Please provide brand name, strength, dosage, and intended use for all supplements, as well as the date they were first given. Ex: Fish Oil, Nordic Naturals - 1500mg per pump, 2 pumps once daily for joint health, started at 2 yrs old in 2010 ; Wei Qi Booster, Jing Tang Herbals - 500mg per tsp, 2 tsps twice daily for respiratory health, started Jan 2020(Required)
Brand Name / Home Cooked
Formualation
Amounts
Date Started
Comments
 
Does your pet have any allergies or adverse reactions to medications?(Required)
Please list your pet's vaccine history. When was your pet last vaccinated? Ex: Rabies June 2019 ; Distemper: June 2019(Required)
Vaccine
Date
 
Please provide a detailed list of ALL veterinary practices your pet has visited across their life. If it has been more than four years since your pet has seen the veterinarian and there were no major concerns at that time, you do not have to list them. Please list all facilities your pet has visited pertaining to their current diagnosis. We will use this list to be sure we have the most up to date records. Incomplete medical records may warrant rescheduling of your pets appointment.(Required)
Veterinarian
Veterinary Hospital/Facility
Town and state
Date visited
Reason for visit
Upcoming appointments
Comments
 
Drop files here or
Max. file size: 200 MB, Max. files: 5.
    Any additional files or documents, including medical records, that you would like Dr. Pope to review may be submitted here.