Welcome To The

Pet Advocate's

Town Hall

A place especially for the serious advocate

Client Information Sheets

WHAT!!! Your veterinarian didn't give you a Client Information Sheet (CIS) to inform you about the possible adverse effects associated with your pets' drugs / vaccines??

Please take a few minutes to complete our survey.

We are in the process of creating a central database of client surveys. We are hopeful that this information will assist Pet Advocates with their efforts to implement Full Disclosure / Informed Consent legislation throughout the United States. Your contribution to this project will only be made available by us to Politicians and to Pet Advocates who are working in an effort to initiate legislation. You can submit your information in the form of a letter or by copying EVERYTHING in the white space below and completing the questionnaire. E-mail the information to ZBirdBrain

Client Information Sheet Survey

Feel free to provide as much information as you'd like but if you do not wish to provide all of the information requested then please just answer the questions that you are comfortable with. We must ask that you PLEASE be sure to include the STATE in which the veterinarian's office is located. 

If you have more than one pet please complete a separate survey for each.

Your First Name or Initial:

    
Last Name: 

   
E-mail:

   
City: 

    
STATE (very important):  

    
Pet - Dog (breed), Cat, Ferret, Bird, Other:

     
Pet's Name:

     
Pet's Age:

      
Purpose of Vet Visit:   


Date of Appointment: 

   
Vet / Clinic Name:

    
City:  

  
State:   

 
Drugs / Vaccines Administered or Prescribed:

    
Were you provided with a Client Information Sheet?   


Was the medication in the manufacturer's original container or had the veterinarian repackaged it into a dispensing container?


If in the original container, was the Client Information Sheet torn off?

 
If you requested a Client Information Sheet what excuses were given for failure to provide the information?  

  
Were you verbally advised of the benefits / risk / possible side effects / adverse reactions associated with the product?

   
If you had been aware of the known risks associated with this product would you have agreed for it to be administered to your pet?   

          
Did your pet suffer an adverse reaction? 

     
If so, did your vet report the event to the product manufacturer?      


Do you believe permanent injury or death was caused by using this product?     


If further veterinary expenses were incurred as a result of using this product how much do you estimate those expenses to be?

     
This information will be made available to Pet Advocates who are making efforts to implement such legislation and to Politicians in an effort to show the need and support for such legislation. Do you give your permission for the information you have provided to be used in an effort to initiate Informed Consent / Full Disclosure legislation?     

       
 

Please copy and paste survey into the body of an e-mail and send the information to ZBirdBrain

  Please do not send attachments.

Do you want to make life better and safer for pets? Please join us at  http://groups.yahoo.com/group/PetAdvocate101/

We sincerely thank you for supporting our efforts to initiate changes that will protect our pets.

If you are denied Client Information Sheets please contact your State Representatives and suggest that they propose a bill that will require Informed Consent / Full Disclosure within the veterinary medical community in your state.