Blue Sparrow Holistic Veterinary House Calls New Client and Patient Intake Form

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Blue Sparrow Holistic Veterinary House Calls New Client and Patient Intake Form

Form Instructions

This form must be completed by the owner/guardian of the pet(s). This form has three sections: Owner/Guardian Information, Pet Information, and Important Blue Sparrow Information and Policies. If you have more than one pet to enter, please enter one pet's information at a time. After submitting information for one pet, you'll be prompted to add additional pets if needed. Please be as thorough and complete as possible. If you submit this form after-hours, over a weekend, holiday closure or day we are not available, please allow 1-3 business days for a response. Thank you for your patience and understanding!

Important Disclaimer Regarding Our General Availability

As a small, single-doctor, housecall-only practice, we're unable to offer on-call services. Dr. Araba provides Primary Integrative Care, Complementary Holistic Care, Hospice Care and Humane Euthanasia Services, and typically sees a maximum of 4-5 appointments per day. Due to our small size, limited daily appointments, and the logistics required for house call appointments, we require all appointments to be scheduled at least one business day in advance, and we are unable to accommodate same-day or urgent care appointments for new patients. If your pet is experiencing an emergency, please visit your nearest emergency veterinary clinic.

Business Hours

Veterinary Appointment Services: Monday - Thursday 10:00 am - 6:00 pm; Friday 10:00 am - 5:00 pm

Administrative Services: Monday - Friday 8:00 am - 6:00 pm

Weekends & Holidays: CLOSED

2025 Holiday Closures (Subject to Change)
May 26: Memorial Day
June 19: Juneteenth
July 4: Independence Day
July 16 - 25: Dr. Araba - Out of Office
September 1: Labor Day
October 13: Indigenous People's Day
November 11: Veterans Day
November 27 - 28: Thanksgiving
December 24 - January 2, 2026: Winter Holidays

Providing Your Email

By providing your email address, you consent to receive emails regarding our services, your pet's health, medical reminders and news from Blue Sparrow Holistic Veterinary House Calls. Please see our Privacy Policy and Terms & Conditions for more information.

Email *

How did you hear about Blue Sparrow Holistic Veterinary House Calls? *

Primary Owner's/Guardian's First and Last Name *

Primary Owner's/Guardian's Phone Number(s) *

Primary Owner's/Guardian's Consent to Receive SMS Text Messages from Blue Sparrow Holistic Veterinary House Calls at the Provided Phone Number.

By providing a telephone number and submitting the form you are consenting to be contacted by SMS text message from Blue Sparrow Holistic Veterinary House Calls. All of our SMS text messages are conversational with our staff members regarding your pet's health, appointment scheduling and the services we provide. Message frequency varies. Message and data rates may apply. Reply STOP to opt-out of future messaging. Reply HELP to get support. Please refer to our Privacy Policy and Terms & Conditions for more information.

By checking this box, I consent to receive SMS messages from Blue Sparrow Holistic Veterinary House Calls.

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What is the best way to reach you? *

Call

Text

Other:

Other Owner's/Guardian's First and Last Name

Please list the first and last name of any other person that share ownership of your pet(s) and/or can make decisions for your pet(s).

Other Owner's/Guardian's Relation

Describe the other owner/guardian's relation to you and your pet. Example: Spouse, Partner, Parent, Sibling, Roommate, Pet Sitter, Dog Walker, etc.

Other Owner's/Guardian's Email Address(es)

Other Owner's/Guardian's Phone Number(s)

Other Owner's/Guardian's Consent to Receive SMS Text Messages from Blue Sparrow Holistic Veterinary House Calls at the Provided Phone Number

By checking this box, I consent to receive SMS messages from Blue Sparrow Holistic Veterinary House Calls.

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Appointment Location - Street Address, City, State, Zip Code *

This is the address where house call appointments will be performed. (Please note, our service area includes: San Francisco, Sausalito, Berkeley, Emeryville, Oakland, Piedmont, Alameda, South San Francisco, Brisbane, San Bruno, Broadmoor, Daly City, and Colma. We have temporarily suspended service to North Pacifica - Westview, Edgemar-Pacific Manor, and Sharp Park.)

Home Address - Street Address, City, State, Zip Code

Your home address, if different from the appointment location above.

Please describe the parking in your neighborhood along with any special parking instructions. *

Please include if you are able to provide parking accommodations.

When is street cleaning on your side of the street and the opposite side of your street? Are there any other parking restrictions on your street? (ie. No stopping/parking during certain hours.) *

Are there any special arrival instructions including any COVID safety protocols we should follow?

Examples: "Doorbell does not work, please call;" "Doorbell frightens pet, please knock/call;" or "Entrance around back;" etc.

We are no longer practicing COVID protocols during appointments, but will gladly accommodate individual requests to practice COVID safety protocols during appointments. If you would like our staff to practice any COVID safety protocols (masking, socials distancing, abstaining for touching doorknobs and surfaces, etc), please include those specific instructions below.

What is your and your pet's availability like during our appointments hours, or do you have any preferred days that work best for you and your pet? *

Our Appointment Hours
Mondays, Tuesdays, Thursdays: 10:30 am - 6:00 pm

Fridays: 10:30 am - 5:00 pm

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