Veterinary Orthopedic & Sports Medicine Group

New Client Form
Please note that due to high volume in the current environment, it may take up to 5-7 business days for a VOSM representative to reach out to you on your submission once all of your records pertaining to this injury are received
Owner Information
Owner Name*

First NameLast Name
Co-Owner/Handler Name

First NameLast Name
In the last 14 days, have you been quarantined, tested positive for COVID-19, experienced any cold or flulike symptoms (including fever, cough, sore throat, respiratory illness, difficulty breathing), or near someone whom has experienced any of the above scenarios?*

YesNo
Are you out of state?*

Yes (My residence is outside of Maryland)No (I live in Maryland)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Pet Information
Pet Name*
Pet D.O.B/Age*
Pet Weight*
Species*

CatDogOther
Pet Breed*
Pet Coat Color*
Pet Sex*

MaleNeutered MaleFemaleSpayed Female
Primary Care Veterinarian*
Primary Care Veterinary Practice*
Primary Care Practice Phone Number*
Please enter a valid phone number.
Has the animal been diagnosed?*

YesNo (VOSM is my first stop)
Please list any current medications, as well as dosages and amounts per dose:*
If not applicable, type N/A
Pet's activities (please select all that apply)*

AgilityBreedingCompanionHuntingObedienceShowingOther
Pet's Illness History / Diagnosis:*
If not applicable, type N/A. Please list all history and diagnostics that have been done with the pet
When did the symptoms begin?*
If not applicable, type N/A
What are the current symptoms?*
If not applicable, type N/A
Weight Bearing (Can the animal put pressure on the injured limb(s)?*

YesOn OccasionNo
Swelling (Is there visible swelling on or around the limb(s)?*

YesNo
Have your pet's eating habits changed?*

YesNo
Has your pet’s issue/discomfort gotten worse over the past 2 weeks?*

YesNo
When was the last consultation/visit with your primary veterinarian or veterinary specialist?*
If not applicable, type N/A
Have you tried any form of pain management/pain medication for this issue yet?*

YesNo
If yes, what pain medication have you tried?*
When was the last dose of pain medication?*
Did this pain medication help relieve symptoms/discomfort/pain in your pet?*

YesNo
Has your pet had blood work done within the last six months?*

YesNo
Have X-rays/imaging been taken of the injured limbs?*

YesNo
In order to efficiently schedule your pet’s appointment, please forward 6 months of your pet’s medical history/notes, diagnostic imaging/tests (x-rays, bloodwork, ultrasound, etc) and reports to scheduling@vosm.com.
Does your pet have any other medical conditions? If yes, please describe:*
If not applicable, type N/A
Have you ever been to VOSM before?*

YesNo
Are you interested in exploring surgical options?*

YesNo
How did you hear about VOSM?*

Friends / Family ReferralReferring VeterinarianGoogle SearchWebsiteSocial MediaPrint/Ad MediaEvent SponsorshipI am a former clientOther
Please upload any medical records or imaging files

Cancelof
I understand that I am responsible for submitting Patient Medical Records.*

I agree
Please remember to send x-rays and medical notes to scheduling@vosm.com!
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New Client Form

Owner Information

Pet Information