Please select the VEI location you would like us to send the completed forms.
Secondary Owner or Emergency Contact
Please complete the following for the pet we are seeing today.
Primary Veterinarian (if different from above)
How did you hear about us?
All fees are required to be paid in full following the completion of your visit. VEI accepts Mastercard, Visa, Discover, American Express, Care Credit, and cash. We do not accept checks.
Emergency examinations will include an additional emergency fee. Please note, additional fees for diagnostics or treatment may be necessary and can vary by patients condition. A written estimate for any procedure done outside of our standard ophthalmic examination can be provided before any work is performed. Please feel free to ask with specific questions.
Initial Eye Exam History
Please answer the following questions to the best of your ability. You may not know the answer to all of the questions and that’s okay. This information will help us to have a better understanding or your pet’s condition. This questionnaire typically takes about 10-15 minutes to complete.
5. Approximately how long has the problem existed?
8. Does your pet have any allergies?
17. When was the last time your pet had lab work performed?
VEI/MedVet may use and disclose information from your pet’s medical record, including medical information, demographic information, and images for educational and learning purposes, scientific investigations, and research publications. Your pet’s information may be disclosed to veterinarians, veterinary technicians, students, research collaborators, and other personnel within and outside of VEI/MedVet. All personal identifying information will be removed prior to disclosure to individuals outside of VEI/MedVet and prior to presentation and/or publication.
I authorize use of my pet's information for educational and research purposes.
I authorize use of my pet's first name, photograph and clinical information on Veterinary Eye Institute/MedVet’s website, social media, news media page or within informational pamphlets. Under no circumstances will my name, my personal or financial information be shared through these media sources.