Equine Client Center

Online Medical Records

With AllyDVM you can log-in to see your pet's medical records, upcoming appointments and when vaccinations are due. You can also request an appointment or refill your prescription from your computer or mobile device.

Request Appointment

Request an appointment online.

Request Appointment

Request
Refill

Request a prescription refill online.

Request Refill

Pet Records
Sign-In

Sign-In

AllyDVM
Sign-Up

Access your pet's medical records with the AllyDVM app.

Sign-Up

Equine Forms

Click the toggles below to complete your form. If you’re submitting multiple forms, you must click submit after each completed form.

Client Intake Form

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Authorized Agent Name

Email *

Primary Phone *

Mobile Phone

Work Phone

Address *

City *

State *

Zip Code *

Employer *

Occupation *

Date of Birth *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

Emergency Contact

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Do you authorize your emergency contact(s) to make urgent treatment decisions if you are unreachable? *

Yes

No

Do you authorize your emergency contact(s) to receive patient information in addition to your primary care veterinarians? *

Yes

No

Patient Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Presenting problem, special needs, concerns *

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Badger Veterinary Hospital to release patient information to the primary care hospital or veterinarian.

Primary Care Facility

Primary Care Veterinarian(s)

By submitting this form, I hereby authorize Badger Veterinary Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of the patient from Badger Veterinary Hospital.

Spam Blocker
Patient Information Form

Horse Location (Stable Information)

Name *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone *

Patient Information

Owners First Name *

Owners Last Name *

Email *

Horse's Registered Name *

Barn Name

Date of Birth

Sex

Male

Male (Intact)

Female

Female (Intact)

Breed

Color

Brand/Tattoo

Is this horse insured?

Yes

No

Date of last EWT/WNV vaccination

Date of last Influenza/Rhino vaccination

Date of last Potomac horse fever vaccination

Date of last Rabies vaccination

Date of last Strangles vaccination

Has this horse ever been exposed to or shown signs of Strangles? *

Yes

No

Date of last known dental float

Date last dewormed

Products Used

Date of last fecal/result

Does this horse have any drug allergies?

Yes

No

Does this horse have any current medical conditions?

Yes

No

If yes, please list all conditions and current medications prescribed

Does this horse have a history of colic?

Yes

No

Habits/Vices

Current feeding protocol (check all that apply)

Grass hay

Flakes fed/day

Alfalfa/grass mix hay

Grain product

Product Name(s)

Pounds fed per day

Other supplements, etc.

Spam Blocker
Payment Policy

First Name *

Last Name *

Date of birth *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Primary Phone *

Secondary Phone

Email *

Employer's Name *

Employer's Address Line 1 *

Employer's Address Line 2

City *

State *

Zip code *

Spouse/Co-Owner's First Name

Spouse/Co-Owner's Last Name

Spouse/Co-Owner's Employer's Name

Spouse/Co-Owner's Employer's Address Line 1

Spouse/Co-Owner's Employer's Address Line 2

City

State

Zip Code

Emergency Contact First Name *

Emergency Contact Last Name *

Relationship *

Emergency Contact Phone *

Emergency Contact Address Line 1 *

Emergency Contact Address Line 2

City *

State *

Zip Code *

All Services MUST be paid for in full at the time of service, with NO EXCEPTIONS. This shall include routine health examinations, vaccinations, routine laboratory tests, surgeries, emergencies, prescription and non-prescription medications, and supplies.
Payment may be made with cash or credit card (Visa, MasterCard, American Express)

If financial problems exist, please make arrangements with your bank or finance company to cover services rendered.

Payments are due by the 20th of the month. Statements are updated on the last day of the month at which time of billing charges are added to accounts beyond 30 days of age. These billing charges will be the responsibility of the debtor. the monthly billing charges are 1.5% per month (18% annually) or a minimum charge of $5.00 per month. In order to avoid the billing charges, payments MUST be received prior to the end of the month.

If payments are not received and the account becomes delinquent, the account will be subject to collections and/or legal action to enforce the collection of money owed. If this becomes necessary, all expenses incurred in the collection of the debt, including court costs and attorney's fees, shall become the responsibility of the debtor at fault.

I have read the payment policy above. I agree to the terms, will follow the guidelines of this agreement, and acknowledge that I am fully responsible for the charges incurred in the treatment of my animal.

Signature *

Date *

Spam Blocker

Online Medical Records

Request Appointment

Request Refill

Pet Records Sign-In

AllyDVM Sign-Up

Equine Forms

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Horse Location (Stable Information)

Patient Information

New Patients Welcome

Request
Refill

Pet Records
Sign-In

AllyDVM
Sign-Up