Associate Doctor

ASSOCIATE DVM







PROCEDURES



















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TABLE OF CONTENTS


1000 – Associate DVM Position Agreement ................................................................................... 4
1001 – ACTH Stim Tests .................................................................................................................. 6
1002 – After-Hours Care ................................................................................................................. 7
1004 – Alicam Camera System ........................................................................................................ 9
1006 – Anesthesia and Body Temperatures ................................................................................. 10
1008 – Antech Results and Tests Available: ................................................................................. 12
1010 - Appointment Delays .......................................................................................................... 13
1012v - Appointment & Surgeries On-Time ................................................................................. 18
1014 - Appointments Overview for DVM’s ................................................................................... 24
1015 – Blood Transfusions ............................................................................................................ 26
1016 – Boarding Patients Needing Vaccines/Vet Care ................................................................. 27
1017 – Brand Preferences ............................................................................................................. 29
1018 – Buffers and E-Slots ............................................................................................................ 31
1020 – Cardiac Wellness Protocol ................................................................................................ 32
1022 – Client Communication Guidelines .................................................................................... 36
1022.1 – Client Communication Scripts ........................................................................................ 39
1023 – Client Acceptance Tips (CAT) ........................................................................................... 43
1024 – Complications and Client Complaints ............................................................................... 46
1026 – Cryoprobe ......................................................................................................................... 50
1027 - Declaw Principles and Guidelines ...................................................................................... 52
1028 – Dermatophyte Cultures .................................................................................................... 54
1030 – Disagreements About Doctor Production ......................................................................... 55
1032 – Drop-Offs ........................................................................................................................... 56
1032.005 – Ear Hematomas .......................................................................................................... 59
1032.01 – Ear Packing ................................................................................................................... 60
1032.1 - Emergencies .................................................................................................................... 61
1034 – Emergencies when Doctor is Out ...................................................................................... 65
1035 - Exam and Consult Efficiency .............................................................................................. 67
1036 – Exam Room Efficiency ....................................................................................................... 71
1038 – Fecal Positives ................................................................................................................... 77
1040 – Feline Root Resorption Lesions ......................................................................................... 78
1040.1 – Fentanyl Patches ............................................................................................................ 79
1041 – Good Samaritan Cases ...................................................................................................... 80
1042 – Grooms Needing Sedation ................................................................................................ 81
1044 – Heartworm Positive Dogs ................................................................................................. 83
1046 – Hospitalized and ICU Patients ........................................................................................... 85
1047 – Imaging Referrals .............................................................................................................. 86
1048 – Internet Pharmacies .......................................................................................................... 87
1050 – Ivermectin Sensitivity ........................................................................................................ 89
1052 – Lab-work Requirements for Prescription Refills ............................................................... 91
1054 – Lab-work Guidelines ......................................................................................................... 93
1055 – Laser Therapy .................................................................................................................... 96

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1055.2 – Medical Record Efficiency .............................................................................................. 98
1055.2 – Overloaded, Sick Doctor, Rescheduling Clients? ......................................................... 100
1056 – Pain Control Packages ..................................................................................................... 102
1058 – Personally-Owned Pets of Doctors ................................................................................. 104
1060 – Pet Foods Regularly Stocked ........................................................................................... 105
1062 – Pet Food Recommendations ........................................................................................... 106
1064 – Phone Messages from Clients ......................................................................................... 108
1066v – Quality Assurance Checks by Doctors ........................................................................... 109
1068 – Prescription Pet Foods for Non-Clients ........................................................................... 110
1070 – Prescription Refill Approvals ........................................................................................... 111
1071v – Radiograph Submissions via Oncura ............................................................................. 112
1072 – Referring Cases (in-house or outside vets) ..................................................................... 114
1074 – Report Cards and Release Instructions ........................................................................... 115
1075 – Reproductive Services: Financial Analysis ...................................................................... 117
1076 – Stone Analysis ................................................................................................................. 118
1078 – Supervision of Lay Staff by Doctors ................................................................................ 123
1080 – Surgeries by Mobile Surgeons ........................................................................................ 124
1082 – Surgery Guidelines .......................................................................................................... 125
1083 – Suture and Staple Removal ............................................................................................. 128
1084 – Transfer of Cases Among Doctors ................................................................................... 129
1084.1 – Treatment Plan Creating .............................................................................................. 132
1084.2 – Ultrasound Charges and Production ............................................................................ 135
1085 – Ultrasound Tips ............................................................................................................... 136
1086 – Urgent Cares Near Closing Time ..................................................................................... 139
1087 – Urinary Issues .................................................................................................................. 140
1088 – Vacation Requests and Doctor Schedules ...................................................................... 141
1090 – Vaccine Protocols and Requirements ............................................................................. 142
































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1000 – Associate DVM Position Agreement

POSITION TITLE: Associate Veterinarian

SUPERVISOR’S POSTION:
 Owner: for licensed-DVM responsibilities
 Exec Director or Vet Administrator: for non-licensed responsibilities.

RESULT STATMENTS: Helps to reach the company’s vision by providing high quality veterinary
care for clients who are satisfied and referring others in abundance.




TACTICAL RESPONSIBILITIES:
1. Maintain all required legal rudiments required for licensed veterinarians in Texas.
2. Complete appointments, emergencies, surgeries, house-call, in-patient, and drop-off
services for pets and clients as outlined in individual procedures.
3. Provide day-to-day supervision, routing, and support to all lay staff as it pertains to
veterinary care.
4. Maintains appropriate “triage” or priorities of patient care and client service. For
example: Keeps emergency and ICU cases a priority over clients waiting. Keeps clients
waiting a priority over non-critical drop-offs or client phone calls, etc.
5. Monitor and report employee issues to proper managers.
6. Help maintain meticulously clean and organized veterinary treatment/service areas and
DVM office space. This can be completed primarily by DVM’s delegating work to lay
staff as needed.

STANDARDS:
Company-Wide:
1. All work will be performed in accordance with Hospital Policies.
2. All work will be performed according to the General Hospital Procedures.
3. Supervisor will be notified of any issues to be resolved or deadlines that cannot be met
well in advance of the due date.

Position-Specific:
4. Acting as ADVOCATES for all pets by recommending the highest quality medical and
surgical care to all clients in language understood by all clients.
5. Working with clients as A PARTNER to achieve optimal care for their pets.
6. Assure clients leave COMPLETETY SATISFIED AND REFERRING OTHERS in abundance,
even when it requires immediate routing of any unsatisfied clients to management.
7. Recommend and provide above-average level of veterinary services and client service.

TWO RULES: Non-negotiable and Consistent
1. Always offer the BEST quality care.
2. Always assure client satisfaction (or refer to mgmt..)

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SIGNATURES:

Statement of the position holder: I accept the accountabilities of this position and agree to
produce the results, perform the work, and meet the standards set forth in the Hospital
Policies and General Procedures.

Date: _________Signature: __________________Printed Name: _____________________




Statement of the position holder’s supervisor: I agree to provide a working environment,
necessary resources, and appropriate training to enable the accountabilities of this position
(result, work, standards) to be accomplished.

Date: _________Signature: ____________________Printed Name: ___________________




















































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1001 – ACTH Stim Tests


Results Statement: To assure we can maintain an affordable AND reasonably
profitable ACTH Stimulation tests with proper record keeping of
inventory used.

Primary Responsible Position: Associate Vets

Participating Positions: Inventory Manager and Technicians
Why a procedure? The markup on this lab test is higher than the typical markup
because of the high cost of cosyntropin/cortrosyn and the labor
costs/time.
How:

1. Draw blood on the patient. Label the TIME on the tube.
“Sample 1” can also be added.
2. Administer 5 mcg/kg cosyntropin IV (Intravenously ONLY!).
This IV dose saves us and each client hundreds of dollars.
a. Dosage = 0.02 cc/kg
i. (5 mcg/kg)(1 cc/250mcg) = 0.02 cc/kg
ii. 5 lb dog = 0.05 cc
iii. 10 lb dog = 0.09 cc
iv. 20 lb dog = 0.18 cc
3. Click “more stuff” under the ACTH stim test. Adjust inv. used
4. Draw blood one hour after the above step. Label the TIME on
the tube. “sample2” can also be added.



Storage of Cosyntropin: Label the bottle with the date received.
Store FROZEN for 6 months then discard and update inventory

Note:

 The same dosage/storage info is in “Forms – Misc” named
“Cortrosyn”.
 The same dosage/storage info is printed on the inside of the
cabinet door to the injectables cabinet




No Quiz/Demonstration is needed on this procedure. It is a reference procedure







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1002 – After-Hours Care

Results Statement: To assure patients needing vet care after-hours, including
surgeries, are well cared for while clients and staff remain
reasonably satisfied.







Primary Responsible Position: Associate DVM’s

Considerations with our Staff: We have a great support staff who is willing to stay after-hours,
however we must be respectful of their lives outside of the
clinic. We cannot expect all staff to be always readily available
to stay after-hours every single day.

Just like doctors, they may have personal commitments or
scheduling difficulties i.e. they are opening the next day or have
unapproved overtime hours. When they do stay after hours we
must make sure that they know they are appreciated.

In all cases, making requires open communication with the
client and our staff, good judgment, and keeping the patient
care and client the top priority with consideration for our staff.

Communication with Our Team: After informing our support staff of the reasons behind this pet
needing care NOW, ask them, “Are you able to stay for this
emergency/surgery?”

If your support staff CAN stay the doctor will have an increased
role in caring for the patient to help expedite services. One staff
member can be sent home as soon as able.

If your support staff CANNOT stay (for valid reasons using
proper judgment), the patient must be stabilized and referred
to the ER.














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In-Patient Needs Care: What TO Do:

 When an in-patient (boarder, grooming pet, vet patient)
needs after-hours care or monitoring the DOCTOR will
immediately try to contact the owner to let the owner make
the decision.
 If we cannot reach the owner the doctor will make the
determination on what should be done with the pet.
Professional judgment will need to be based on the doctor’s
recommendation but in most cases the pet will need to be
transferred to the emergency clinic by us.
 We will need to leave a voice mail message for the owner of
the plan and that there will be charges associated with this
medical care.
 If the client has checked the “No” box on the emergency
care section of the check-in form, we will be less likely to
perform thorough monitoring or extra charges.

What NOT to Do:

 In either case we will NEVER let a pet suffer in our hospital
under our care or be at risk of death without anyone
present without very special circumstances AND to be sure
that the pet is not left in pain or suffering.


Drill Quiz for “After-Hours Care”:
1. What do you do if there is a boarder needing vet care overnight?
2. In your own words, explain what you will do if you have a pet needing emergency surgery
starting 15 minutes before closing time? What if it has do be done IMMEDIATLEY vs. within the
next few hours? What considerations and steps will you take to make a decision?
3. What if it’s a boarder with GDV and the owner checked “yes”? What if they checked “no”?
























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1004 – Alicam Camera System


We order the Alicam as needed on a patient-by-patient basis AFTER the client as paid for the service
with treatment code 2593 “Alicam Monitoring and Consult” in AVImark.

To order an Alicam call:

Joshua Ahern with Infiniti Medical
Main: 650-327-5000
Direct: 817-304-9738
[email protected]



























































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1006 – Anesthesia and Body Temperatures


Results Statement: To assure patients are safe under anesthesia, including
multiple procedures under one anesthesia event.

Primary Responsible Position: Associate DVM’s



Multiple Procedures While Under Anesthesia:

There will be times where patient anesthetic times will be extended which can lead to
dangerously low body temperatures. We will take every precautions and procedures to
keep patient safety the highest priority.

When we have multiple procedures scheduled while the patient is under anesthesia
doctors will advise that we do the procedure with the biggest medical benefit FIRST. If
the other procedures need to be postponed this will assure the most pressing procedure
has been completed first. An exception to this would be if the client insists that the
lower medical priority procedure is their primary concern and they do not want to risk it
being cancelled. In this case doctors will use medical discretion with both the patient
care and client service being considered. We will always document any client
communication in the patient record.

Example: Scheduled sedated groom with a dental cleaning. In some cases the client
may consider the groom to be the highest priority. If they client does not want to risk
the groom being postponed due to low body temperatures we will do the groom first.

Body Temps:

In general, if the patient’s body temperature is above 95 degrees we will proceed onto
the other procedures as planned. When the body temperature is at or below 95
degrees the doctor needs to use the best judgment in determining if the anesthesia
should be stopped or if other procedures (warmed fluids, heating pad, “bed buddy”, etc)
are needed to increase the body temp.

Doctors will also use their best judgment based on the procedures that are scheduled.

Example: If an animal is scheduled for a dental procedure next and the body temp is 93
we will likely postpone it due the additional length of anesthesia needed and the water
involved. If the animal scheduled for a post op lat view radiograph of the abdomen and
the temperature is 93 we may be able to proceed with the radiograph due to the short
time needed and benefit of post-op rads.

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Drill/Quiz for “Anesthesia and Body Temperatures”:
1. When you have multiple procedures which do you choose to do first?
2. What body temp would you consider as a threshold for possibly postponing additional elective
procedures.











































































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1008 – Antech Results and Tests Available:


Result Statement: To assure all DVM’s can view up-to-date Antech lab test
status at any time online.

To also assure all DVM’s can easily and efficiently run any
Antech test they prefer and charge the appropriate price.

Primary Responsible Position: Associate Vets

Participating Positions: Execs, Department Heads, Techs

To View Results and Trends: Go to: www.antechonline.com or www.zoasis.com
1. Account #: 11584
2. Online ID: 35659
3. Username: legacyvet
4. Password: legacyvet


To request a test NOT entered into AVImark: Login to the website(s) above.

o Find the test you would like to run (under test guide)
o Write down the cost to the clinic.
o Go to the patient’s record and enter treatment code 8056 “Misc Fee”
o Double click on the treatment in the patient record.
o Change the name from “Misc Fee” to the test name and antech code #.
o CHANGE THE CLIENT PRICE TO 2.5 TIMES OUR COST.
o Ask your tech or TA to fill out a requisition form by hand

Note: There are several reasons we do not keep a large lists of tests available in AVImark. The
primary reasons are that we keep the tests most commonly used, the most cost effective for
the client and hospital, and avoid the tedious task of keeping with price changes on the
multitude of tests antech has available. This approach also allows doctors to view all current
tests available through Antech Online rather than what is in AVImark or available when the
Antech book was printed.


Drill/Quiz for “Antech Results and Tests Available”:
1. In front of your trainer log into the antech/zoasis webite.
2. Pretend you are running a Distemper Titer that is not in AVImark. Go to the “practice client”
enter the charge as above with the correct price.






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1010 - Appointment Delays


Results Statement: As part of our core values of “planning” and “professionalism” we make
a promise to our clients that will not have to wait. This creates more
value for our clients and makes us much more unique than other vets!
This can happen because as team members following policies we show
up to work on time and “plan” for those appointments LONG BEFORE
THEY ARRIVE.



Primary Responsible Position: Associate DVM’s

Participating Positions: Reception, Techs, TA’s

Definition: Delayed appointments are defined as any client not being seen within 5
minutes of their scheduled time.

UN-avoidable Delays: Occasionally there are valid reasons why appointment delays are
inevitable. The ONLY reasons there should be a delay (more than 5
minutes beyond scheduled start) are:
1. We had an earlier emergency
2. Urgent cares must wait
3. We had a more critical pet
4. the client arrives late.

Any reason OTHER THAN the above is due to our lack in planning or
managing or client and patient flow: See next page































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EMERGENCIES: within up to four hours prior to current time. See “Emergencies” procedure
o ALL OTHERS WAIT: With emergencies all other
appointments and surgeries all go “on-hold”. We
do NOT have enough scheduled support staff to be
handling emergencies AND regular appointments at
the same time for one doctor.
o WATING CLIENTS ARE GIVEN OPTIONS: The staff
joins to together to inform ALL waiting client and
upcoming appointments of this delay. The client is
given options.
o UPCOMING CLIENTS ARE CALLED: ONLY
Receptionists, Department Heads, or Execs (not
techs or TA’s) will use good judgment to call
upcoming appointments that are likely to be
delayed. The doctor will give estimate of how long
the delay may be. The doctor will over-estimate.
Clients will be offered options (longer wait,
reschedule for later, reschedule for another day if
NOT sick or injured).
 Note: Good judgment on these calls are
critical. For example, if a doctor is in
emergency surgery we may be forced to
reschedule a vaccine appointment for
another day. An itchy dog appointment
may need to be seen today regardless
because the pet is uncomfortable or painful.
MORE CRITICAL PATIENT:
o This is a priority/triage over the appointment
(critical ICU patient, in-hospital emergency)

URGENT CARE: See “Urgent Cares” procedure
o In this case ALL “regular” appointments are seen on
time. The urgent care is the only delay
client/patient with a wait.
CLIENT ARRIVES LATE:
o If the client arrives late and we feel there is a
possibility that we cannot finish in time to start the
next appointment on time:
 We POLITELY offer to work them in while
the other appointments are seen on
time……OR….
 They can reschedule for the next available
time...OR…


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 They may be able to drop off.
















































































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 When are delays AVOIDABLE: Examples or poor
“planning” on our part causing delays would be:
 Surgeries taking longer than expected - We should be scheduling
surgeries for LONGER than expected.
o Note: Doctors NEVER leave or delay a surgery on a patient
under anesthesia unless it’s due to an emergency. This is
part of appropriate triaging.
o For example: A doctor would never have spay waiting
under anesthesia for the doctor to start because that doctor
is doing an appointment, phone call, or exam.
 Surgery cases that become critical – see above. This falls under
appropriate delays above.
 Our staff did not show up to work on time – see hospital policies
 Our staff did not review the records PRIOR to client arriving – see
appointment procedure
 We did not have records or treatment plans ready – See
receptionist procedures when booking.
 We did not get records from previous vets – See receptionist
procedures on getting records PRIOR to client arriving.
 We were on the phone with another client on a long conversation –
We should be able to POLITELY explain we need to see our
appointments on time and will have to call them back. If we are on
the phone too long due a critical patient it would fall under a valid
reason for a delay above.
 The last appointment took too long – We should have moved this to
and “advanced” appointment and kept the “basic” appointments on
time.
 Etc, Etc, Etc……..Too many poor excuses to list here that would
make our clients wait unnecessarily.


























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What to do if we have delays:
It is absolutely CRITICAL that proper client communication is
done when we have a delay. If at all possible we call the client
BEFORE they arrive.

In EVERY SINGLE CASE WE INFORM THE CLIENT OF:

1. THE CAUSE OF THE DELAY
2. THE OPTIONS THEY HAVE
a. They can wait
b. They can reschedule
c. They can drop-off their patient and we will call
when done (get doctor, exec or manager approval
first).

This gives the client the CONTROL of what THEY would like us to
do. In almost every case they will understand why there is a
wait on not be upset. We are not dictating to them what they
HAVE to do.

This also gives the client the opportunity to KNOW WHY and
UNDERSTAND how the delay was not under our control. It is
totally okay to tell the client some details of why another
patient had an emergency and needed to be seen first. We
inform the client how we would do the same for their pet if it
was in the same situation. There is not HIPAA or privacy laws
that keep us being able to share this info. People appreciate the
info.

This communication sets us apart and “disarms” client from
complaining. It shows courtesy, care, and respect for their time.
It also shows that we have our patients as our top priority at all
time.

Drill/Quiz for “Appointment Delays:
1. What is defined as an appointment delay? How long?
2. What are some things that make delays UN-avoidable?
3. When we have an emergency:
a. What happens to all other appointments, drop-offs and surgeries while we stabilize the
emergency and present the treatment plan to the owner?
b. What do we do with the waiting “on-hold” clients during this time?
c. What do we do for the upcoming clients that may be delayed? Who does this?
4. What are examples of delays that are avoidable?
5. What do we do when appointments are delayed?
6. Why do we do it this way? What would happen if we did not?





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1012v - Appointment & Surgeries On-Time

Result Statement: To achieve great client service and on-time appointments and surgeries.
We do this by assuring all key staff members know their roles and work
well together.






What TO do: Keep the priorities in mind of what comes first. Patients and clients are
served in this order
1. Emergencies
2. Critical/ICU Patients
3. Scheduled Clients Waiting
4. Surgeries (if already under anesthesia they move up)
5. Urgent Care & Advanced Appointments
6. Drop-Offs

 Start and finish each appointment ON TIME (90% of the time).
 Start and finish each surgery ON TIME (90% of the time).
 Doctors and support staff must be capable of completing their parts
of appointments and surgeries within their portions of the
scheduled times.
 Inform management if surgeries and appointments routinely cannot
be started and completed as scheduled. More training, support, our
schedule guidelines will need attention.


What NOT to do:
 Schedule any appointments and surgeries during the SAME times.
You can’t be in two places at once
 Unblock surgery block-off time more than 48 hours in advance.
 Seeing patients in the wrong priority order listed above.
 Make your own schedule late when there is another or staff
member available that could handle it.















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“BASIC” Doctor Appointments: Non “exam room efficiency” days or one-room per doctor


Receptionist
1. Proper schedules appointment length
2. Properly confirmed appointment for client to arrive as scheduled
3. Records ready PRIOR to client arriving.
4. Patient is weighed and entered into AVImark check-in
5. Page overhead “CL Doctor ______, (pause)… CL Doctor _________” within 3
minutes of arrival
6. Assure TA greets this client within 2 minutes of page
7. Check-out receptionist checks-out the client per receptionist procedure.

Tech Assistant:

1. “Rounds” with tech, TA, and Doctor: Review appointment schedule and
speak to both tech and doctor so you are prepared to know the patients
name and pertinent history AT LEAST 10 MINUTES BEFORE….AND THE NEXT
THREE UPCOMING APPOINTMENTS. This includes the first appointment of
the day and after lunch.
2. Arrives to reception area within 2 minutes of page
3. Grabs clip board with records/documents/treatment plans
4. Greets patient first, then client BY NAME, introduces him/herself BY NAME
with eye contact and escorts them to exam room.
5. Doctor is waiting in exam room
6. Assists doctor for exam
7. Obtains “TPR” when appropriate (in some cases it can be done after exam in
treatment).
8. Enters “subjective” notes and TPR into AVImark while in exam room.
9. Assists tech with needed services and items AFTER acceptance of treatment
plan with TECH
10. Starts the next appointment with doctor while the tech finishes and releases
this one.






















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Doctor:

1. “Rounds” with tech, TA, and Doctor: Review appointment schedule and
speak to both tech and doctor so you are prepared to know the patients
name and pertinent history AT LEAST 10 MINUTES BEFORE….AND THE NEXT
THREE UPCOMING APPOINTMENTS. This includes the first appointment of
the day and after lunch.
2. Waits for patient, client, and TA in exam room as the TA goes up front to get
the client
3. Greets patient first, then client BY NAME and introduces her/himself BY
NAME with eye contact and preferably with a handshake.
4. Asks clients for their PRIMARY concern first and reason for their visit.
5. Completes exam while also discussing any additional concerns from client or
issues found during exam. Narrates the exam while performing.
6. After the exam the doctor addresses exactly what they plan to do for their
PRIMARY concern first, then each additional concern WITHOUT DISCUSSING
FEES. This often times is best time by hand-writing items on blank piece of
paper in a list.
7. Gets a good idea of client’s acceptance of the recommendations/plans
WITHOUT COST FIRST. If cost is the reason for non-acceptance we have
ways to work with the client to be able to afford or plan for things they
want to do but is not financially feasible today.
8. Asks the client if they have any other questions or concerns.
9. Completes a report card (when appropriate) and reviews with the client
10. Prep the Pet Insurance Conversation: “As a doctor my focus is the CARE of
your pet. Sometimes finances can limit or slow down my care. We have a
way to avoid the financial burden of the unexpected. I will ask (name)
show you how we do this. It’ll take less than 5 minutes.”
i. If not rushed you can share a story of how it helped a pet or client
and discuss how you don’t get a commission or anything from it.
11. Meets with TECH outside the exam room and dictates a “tech sheet” or
“travel sheet”.
12. Enters notes into the medical record BEFORE moving onto the next
appointment.

Technician:

1. “Rounds” with tech, TA, and Doctor: Review appointment schedule and
speak to both tech and doctor so you are prepared to know the patients
name and pertinent history AT LEAST 10 MINUTES BEFORE….AND THE NEXT
THREE UPCOMING APPOINTMENTS. This includes the first appointment of
the day and after lunch.
2. Meets with doctor outside exam room and completes tech sheet with
treatment plan, services, meds, etc.




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3. Presents treatment plan without the doctor present (already discussed and
verbally approved with doctor without prices). Gets final verbal approval
and acceptance
4. If client unexpectedly objects to items recommended they inform the
doctor prior to starting the procedures.
5. If unexpected objections arise due to cost we can start the other procedures
and have the client visit with our client coordinator or exec for financial
arrangemements
6. Performs the services as appropriate either in treatment or exam room with
the assistance of the TA.

7. Releases patient with proper release form or report card


“ADVANCED” Doctor Appointments: Unexpected things happen that could cause us to not be able to
see the next scheduled appointment within 5 minutes of
scheduled time.





Tech, TA, or DVM:

1. Inform the client:
a. The reason that the appointment has become advanced.

Example of what to say:

“It looks like we are needing to do a few more things for (pet name) than we had planned and
scheduled for today. In order to keep our other appointments on time today we will need to
have (pet name) dropped off for the services and we will call you when he/she is ready.

You are also welcome to wait up front (will be wait) OR schedule these services for another day
(if not critical and owner will still for sure do them). What is best for you?”

b. OVERESTIMATE how long you think it will be. Double the length of
time you think it will take.
c. We will continue to work on their pet while still seeing next
appointment on time
d. They will need to wait in another exam room or in our reception
area.
2. Tech or TA moves the client to another exam room, reception area, gets
documentation needed for drop off.
3. Tech, TA, and doctor keeps client informed every 5-10 minutes while they
wait.

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EXAM ROOM EFFICENCY: The room tech does EVERTHING in exam room (assist doctor, present
treatment plan, release. The treatment tech and TA perform lab tests and any service in treatment.
See detailed procedure.


URGENT CARE: See above under “advanced”. It is the same although we discuss how
we will fit them in and THERE WILL BE A DELAY. We likely will not
know how long that delay will be. There are times when the delay will
be until ALL appointments are completed during that block. They
always have options of 1. Rescheduling 2. Waiting or 3. Dropping off
(with approval).

EMERGENCIES: The doctor and needed support staff drop all other patient care and
client service and triage/stabilize this patient as necessary then moves
back to their regularly scheduled appointment explaining reason there
was a delay.

Receptionists, techs and TA’s communicate with any clients that may
have delay and why. They are given options – see above.


Drill/Demonstration for “Appointment Flows and Staying On Time”:
1. Explain in your own words what the result statement means to you.
2. Why do we have this procedure this way? What would happen if we didn’t?
3. Explain what doctors, techs and TA’s do to “round” before appointments. When do you do it?
Before the first appointment of the day? How many appointments in advance? Why do we do
this? How does it help you?
4. With your trainer acting as a client explain what you say when an appointment becomes
advanced. Do not move on to the next step until you say this comfortably and friendly.
5. Demonstrate to your trainer using demo pieces or Lego people of how you would handle EACH
type of appointment in YOUR position



























[22]

[23]

1014 - Appointments Overview for DVM’s


Result Statement: To maintain properly scheduled appointments with client
arriving on time and seen within FIVE MINUTES of their
appointment time. The only times appointments are not
started on time is with 1. Urgent Care Visits or 2. Emergencies
that delayed our regular appointments.



Primary Responsible Position: Associate DVM’s

Participating Positions: Receptionists, Techs, and TA’s

THREE basic types of appointments: Regular, Urgent, and Emergencies

1. Regular: These can be grouped into various types
i. “BASIC” Doctor Appointments - started and finished AS SCHEDULED unless we
have had an emergency within 4 hours prior.
ii. “ADVANCED” Doctor Appointments - unplanned events/services causes it to
take LONGER than scheduled. This could be from an extra problem found on a
pet, extra tests, waiting on records, etc.

Example of what to say:

“It looks like we are needing to do a few more things for (pet name) than we had planned and scheduled
for today. In order to keep our other appointments on time today we will need to have (pet name)
dropped off for the services and we will call you when he/she is ready.

You are also welcome to wait up front (client will be waiting until we are caught up) OR schedule these
services for another day (if not critical and owner will still for sure do them). What is best for you?”
iii. GROOMING: Started and finished on time as promised. If vet services are
included, it will save both us and he client time if these are scheduled and
“express TA” appointments.
iv. TECH INTAKES OR RELEASES: Started and finished on time as promised. These
could be regular tech visits or “express TA” scheduling.
v. BOARDING DROP-OFFS: These are NOT scheduled as client appointment
UNLESS vet services are included. If so it will save us and the client time if they
are scheduled as an “express TA” appointment which would make this fall under
Techs as in “d” above.
2. Urgent Care:
These are basically our fit-in appointments. These are non-emergencies when
we don’t have appointments available but patient needs to be seen now (based
on patient needs OR client request). Clients are informed that there WILL BE A
WAIT.

[24]

3. Emergencies:
The doctor and support staff for this case DROPS EVERYTHING NOW! This does
not mean that EVERYONE drops everything, only the staff needed for this case.
In some cases, we may have more than one emergency at a time. ALL other
appointments for that doctor WILL BE DELAYED.

1. ALL OTHERS WAIT: With emergencies all other appointments and surgeries
all go “on-hold”. We do NOT have enough scheduled support staff to be
handling emergencies AND regular appointments at the same time for one
doctor.
2. WATING CLIENTS ARE GIVEN OPTIONS: The staff joins to together to inform
ALL waiting client and upcoming appointments of this delay. The client is
given options.
3. UPCOMING CLIENTS ARE CALLED: ONLY Receptionists, Department Heads,
or Execs (not techs or TA’s) will use good judgment to call upcoming
appointments that are likely to be delayed. The doctor will give estimate of
how long the delay may be. The doctor will over-estimate. Clients will be
offered options (longer wait, reschedule for later, reschedule for another
day if NOT sick or injured).
4. Note: Good judgment on these calls are critical. For example, if a doctor is
in emergency surgery we may be forced to reschedule a vaccine
appointment for another day. An itchy dog appointment may need to be
seen today regardless because the pet is uncomfortable or painful.


Drill/Quiz for Appointments Overview for DVMs:

1. Explain the difference between an advances vs. a basic appointment. What do you do with
advanced?
2. In your own words and your trainer acting as a client explain what the client can do when we
have an advanced appointment. Don’t move to the next question until it comes out
comfortably and friendly AT LEAST TWICE.
3. Explain what an urgent care is. What would you do if you are working on an urgent care and
your next appointment shows up on time?



















[25]

1015 – Blood Transfusions








Contacts:

Canine Blood Heroes: 208-346-2542 email: [email protected]

Emergency and Referral Hospitals: Try all of them.

























































[26]

1016 – Boarding Patients Needing Vaccines/Vet Care

Results Statement: To achieve the highest quality of care for boarders needing
vaccines. We do this in a way that is consistent for staff and
safest for the pet.




NOT close to closing time:
 If it is NOT within one hour of closing, we examine and
vaccinate as usual.
 There are times when we have extremely busy days and it is
in everyone’s best interest, including the patient’s, to
postpone examining, vaccinating, etc. today’s drop off
boarders needing vaccines. In these cases, it will be
completely left for the most appropriate doctor the next
day (drop off doctor). Any client requesting a specific
doctor will override this procedure and will be done by that
specific doctor.
Within one hour of closing time:

o Each doctor will use their best medical judgment if a
boarder is in need of vaccines within a few hours of closing.
This judgment will assure patients are protected as soon as
possible but also lessen the risks of vaccine reaction
happening without doctors present.
o If the patient has been prepped for doctor less than one
hour before closing, the doctor will examine patient,
complete records, report cards, etc that day. They will also
instruct technicians to vaccinate first thing the next day by
writing instructions on the technician board and
documenting in record.
Boarders Noticed That Need a Vet:

 Ear/skin problems – Owners to be notified BY TECHNICIAN. Documented approval of exam fee
BEFORE it gets put on treatment board for the doctors.
 Diarrhea – No exam fee. meds/food charged and scripted. Owner notified BY THE DOCTOR.
 Hurt or critical. Automatic free exam by doctor. Meds or food is scripted. Owner is notified BY
THE DOCTOR. Most all injuries will be free to owner because it happened under our care.
Doctors will use judgment if charges are needed because of a predisposing condition.








[27]

Drill/Quiz for Boarding Patients Needing Vaccines/Vet Care:
1. Explain exactly what you do if a boarder is dropped off for boarding within one hour of closing
and needs vaccines.
2. If you are swamped and there are boarders needing vaccines more than one hour prior to
closing but you don’t have time can you postpone the vaccines until tomorrow? What is best to
do?
3. Explain when a boarding client would or would not get charged for an exam on a pet that had a
problem while boarding
a. With diarrhea?
b. With an ear infection?
c. When they tripped on our step and fell?






























































[28]

1017 – Brand Preferences

Results Statement: To assure great patient care by recommending the best!

Primary Responsible Position: Doctors

Participating Positions: All


What to Say: “Our doctors have CAREFULLY selected products and pet foods we
keep fully stocked. We do this so you can be comfortable knowing
your pet is on the safest, highest quality, and most cost-effective
products. We also do this because it is impossible for us to remain
stocked with every brand.

If your pet requires something different let us know. We can easily
get it for you.

You can also order all medications and pet foods directly through our
mobile app, in most cases with free shipping”


Condition: Product : Company:
HEARTWORMS, FLEAS & TICKS:
Hw Only – 1 Choice ProHeart Zoetis
st
nd
Hw Only - 2 Choice/Oral Tri-Heart Merck
Hw/Flea/Tick - Feline Revolution Plus Zoetis
st
Flea & Tick – 1 Choice Bravecto Merck
nd
Flea & Tick - 2 Choice Simparica Zoetis

NSAIDS:
Carprofen Chewable Generic See Distributor
Meloxicam Liquid Generic See Distributor
Onsior – Feline Onsior Elanco

PET FOODS:
Dental Diet: Dental - Royal Canin
Atopy Derm Purina
Cancer/Recov/Neonate Recovery Royal Canin
Cardiac Heart & Kidney iVet
Diabetes (K9) OM Purina
Diabetes (fel) DM Purina
Food Allergy Trial z/d Hill’s
GI Disease (Acute) EN Purina
Inflam Bowel Disease (K9 +fel) Hydrolyzed Royal Canin
Liver l/d Hill’s
Maint. Dog &Cat Food: iVet iVet
Neuro Neurocare Purina
Osteoarthritis j/d Hill’s
Overweight (K9 and fel) Weight Reduction iVet
Puppy/Kitten Food: Puppy/Kitten iVet
Renal Disease (K9 and fel) NF Purina
Urinary Stones SO – Mod Calorie Royal Canin

[29]

Why: This procedure is how we assure our products are safe, effective, and IN STOCK. It also
increases client trust by hearing the same recommendations from the entire team.

Comments:

ProHeart: The primary reason this is our first choice is compliance.
 The average client compliance is nationwide is less than 40%.
 One dose of ProHeart alone is over 50% protection.
 For puppies give the dose for the current weight, as early as 12 weeks of age (off-
label and not for giant breeds, or large breeds)
 Give Tri-Heart leading up to the first dose of ProHeart


Bravecto: The primary reason for this is our first choice is also compliance.
 Patience have better overall yearly protection when given a 3-month dose.
 For highly cost-conscious clients and puppies 12 weeks and older (off-label),
Simparica is an alternative.


















































[30]

1018 – Buffers and E-Slots


Results Statement: To avoid, as much as possible, being overbooked to point of
running behind on appointments. This procedure helps clients
get seen on time while keeping staff and doctors able to have
lunch and shift ending-times….which ultimately keeps both
clients and staff happier.

Appointment Buffers:

Each Doctor will have a 20-minute buffer appointment before the end of their block of
appointments. This buffer gives the doctor time for lab call backs or time to catch up if
appointments are running behind.

Example: If a doctor is scheduled from 11 AM – 8 PM. Buffer will be before lunch at
3:40 and at the end of the shift at 7:40.

Exception: There will not be a buffer on a day that there is a transition from
appointments to surgery for the

Appointment E-Slots:

Each doctor will have a 20-minute E-Slot in the middle of each block of appointments. This
block-off will be removed each morning. This block-off will keep us from completely booking a
block of appointments the day before. It also allows us to open up a slot each morning for sick
patients.

Note: This slot can be moved up or down a little to accommodate appointment lengths
needed to fill in.

Example: A doctor has appointments from 8-Noon and 1-5 PM. E-Slots can be from
9:40 – 10 AM and 2:40 – 3 PM.

Drill/Quiz for Buffers and E-Slots:
1. Explain the appointment buffers and e-slots in your own words.
2. Why do we have these? What would happen if we did not?

















[31]

1020 – Cardiac Wellness Protocol

Results Statement: To support our efforts in providing consistent care to patient with
cardiac issues and/or valve disease, this protocol serves as a GUIDELINE
for our practitioners, staff, and owners. Owner education will occur at
the doctor level with support from technical staff.

Heart disease at different stages: The time spent at each stage varies from dog to dog.

 Stage A: Dogs at high risk to develop heart disease but with no murmur or clinical signs.
 Stage B: A murmur is heard but no outward signs are seen.
o Stage B1: No heart enlargement is seen on X-Ray.
o Stage B2: The heart is getting big on X-ray.
 Stage C: Outward signs of heart trouble is seen and treatment is necessary.
 Stage D: Heart failure is getting hard to manage

Stage A: Dogs at high risk to develop heart disease but with no murmur or clinical signs.

 Recommend baseline chest radiographs (2 views)
o If no heart enlargement is seen on rads and patient stays in Stage A we would
recommend repeating rads every 3 years on patients 0-6 years old and yearly on those
patients 7 and older.
o If heart enlargement is seen patient is in stage B2 and the proper protocol should be
followed as listed below or sooner if clinical signs develop

Stage B1: Murmur is heard but no outward signs are seen
 Recommend baseline chest radiograph (2 views)
 Recommend baseline bloodwork: CBC/Chem/Lytes (Superchem/CBC Antech SA020)
 Add Findings to AVImark Patient Record:
o Murmur Grade (score out of 6)
o Point of maximal intensity
o Vertebral Heart Score (VHS)
o Diagnosis in AVImark: Cardiac Valve Disease Stage A-D
o Treatment Plan: In the “P” under the SOAP or as a follow-up.
o Diagnosis Code in AVImark should link release document for owner and set a reminder
for follow-up visit in AVImark.
 B1: Recheck in 12 months; sooner if clinical signs develop
 B1: Owner release document and worksheet provided for B1 Valve Disease Stage to go home as
a release document.













[32]

Stage B2: Murmur is heard and heart is getting big on rads.
 Recommend baseline chest radiograph (2 views)
 Recommend baseline bloodwork: CBC/Chem/Lytes (Superchem/CBC Antech SA020)
 Add Findings to AVImark Patient Record:
o Murmur Grade (score out of 6)
o Point of maximal intensity
o Vertebral Heart Score (VHS)
o Diagnosis in AVImark: Cardiac Valve Disease Stage A-D
o Treatment Plan: In the “P” under the SOAP or as a follow-up.
o Diagnosis Code in AVImark should link release document for owner and set a reminder
for follow-up visit in AVImark.

 No evidence that medications will help at this stage.
 Recheck in 6 months; sooner if clinical signs develop
 Owner release document provided for B2 Valve Disease Stage to go home with owner at
release.
 Owner is to monitor the respiratory rate at home at least once a week. If the rate increases by
1/3 they should contact us.
 Owner release document and worksheet provided for B2 Valve Disease to home with owner at
release.













































[33]

Stage C: Outward signs of heart trouble are seen and treatment is necessary. Patient always has
cardiomegaly and pulmonary edema
 Recommend baseline chest radiograph (2 views)
 Recommend blood pressure (5 readings 1 minute apart)
 Recommend Echo.
 Recommend baseline bloodwork: CBC/Chem/Lytes (Superchem/CBC Antech SA020)
 Recommend Full ECG (code 7081 in AVImark)
 Add Findings to AVImark Patient Record:
o Murmur Grade (score out of 6)
o Point of maximal intensity
o Vertebral Heart Score (VHS)
o Diagnosis in AVImark: Cardiac Valve Disease Stage A-D
o Treatment Plan: In the “P” under the SOAP or as a follow-up.
o Diagnosis Code in AVImark should link release document for owner and set a reminder
for follow-up visit in AVImark.

 Always treat with pimobendan. Don’t wait.
 Will likely also need Benazepril and Lasix.

 Recheck in 7 days; sooner if clinical signs worsen. Same recheck needed if there is a big change
in med dosages.
o Renal Profile (Antech SA310) – for lytes, BUN, Creat
o Chest Rads
o Blood Pressure
 Once stable standard recheck in 2-3 months.
 Call client in 2 weeks (add follow-up for doctor). If not doing well we will need to recheck
sooner.

 Owner release document provided for C Valve Disease Stage to go home with owner at release.
 Owner is to monitor the respiratory rate at home at least once a week. If the rate increases by
1/3 they should contact us.
 Owner release document and worksheet provided for C Valve Disease to home with owner at
release.






















[34]

Stage D: Heart failure is hard to manage and refractory to triple or quad therapy. Diuretic, VetMedin,
Benazepril and possibly Sprinolactone all BID if possible and still refractory.
 This stage needs all tests from stage C current.
 Will likely need referral or consultation with cardiologist.
 May need oxygen therapy and hospitalization with oral meds, IV lasix, etc.
 Multiple drugs are needed and often allows lower dosages of lasix.
 Diagnosis in AVImark: Cardiac Valve Disease Stage A-D
 Professional judgment from the doctor on the case is critical to the survival of the patient.
 Owner release document and worksheet provided for D Valve Disease to home with owner at
release.

Pre-Anesthetic protocol/risk for Cardiac Cases: Follow cardiac workup as listed above to classify the
cardiac disease before considering anesthesia.

Stage A and B1: Should be fine for anesthesia. The best anesthetic protocol is the one the doctor is the
most comfortable with.

Stage B2 and C: Avoid anesthesia if at all possible. Recommend referral to cardiologist before
considering anesthesia. If anesthesia is required and client declines refer consult with cardiologist
before proceeding.

Stage D: Do not anesthetize unless it is an emergency and no other option is available. Prognosis with
anesthesia is poor.



This is a reference procedure. No drill/quiz is needed.

































[35]

1022 – Client Communication Guidelines


Results Statement: To assure we have friendly, appropriate, and convenient
communication that is always documented.




Primary Responsible Position: Associate DVM’s

General Guidelines:

 All client communication is documented in AVImark with
“date/time stamp”
 Lay staff follows this policy also
 All refill authorizations from outside pharmacies are documented
as a follow-up.
 If it’s not documented, it didn’t happen.
 If a client is up front or on the phone and you are not swamped,
we have found that clients bond better if the doctor personally
handles the question, rather than calling them back. This will
increase loyalty, compliance, and quality of patient care. You
can feel free to talk to owners in exam rooms or up front if you
have time available.

AVImark Follow-Ups:
 Type it in: All doctor-client communication, even leaving
voicemails, must be documented THAT DAY, preferably
immediately. The longer we wait the higher the risk for
client complaints and wasted time for many.
 Leaving Voicemails: In all cases it must be listed as more
than just “left a VM….”. Other doctors may be forced to
field this return call. They need to be educated enough to
help the client.
o Quick Notes: If it’s a quick recheck needed or
maybe a medication the client needs to pick up,
WRITE THAT IN THE FOLLOW-UP.
o Complicated Plans: If there’s a long, detailed plan
that needs to be discussed you can write the very
brief “cliff notes” and that you would personally
discuss the case when you are back in the office.
This only applies if it’s helpful to the pet and
client…AND NOT an effort to be possessive of the
case or production.



[36]

Personal Cell Phones:
Doctors giving out their personal cell phone #’s can be very
helpful to everyone if handled correctly. If not handled
correctly it often leads to:

1. Confusion & wasted time for doctors, staff, and clients
2. Inconsistent client service – different from other docs.
3. Legal problems with Confidentiality & Non-Compete.
4. Wasted time for doctors and staff.

As a result, in the vast majority of cases it is easier and BETTER
NOT TO GIVE OUT personal cell phone #’s. If a doctor chooses
to give their cell #’s here are the required rules & guidelines.

MUST DO’s - These are not optional:
 Have a friendly supportive conversation
 Offer general advice on pet care or tips, NOT A PLAN!
 Always end the call with “I cannot book appointments,
prescribe, or offer specific medical advice. when I am
not in the office. The staff and doctors at the hospital
can help you with all this. Please call the hospital.
Okay?”
 Call the hospital NOW (30 minutes max) to delegate a
team member to enter the follow-up in the patient
record - 30 minutes max.

DON’T DO’s – These are not optional:
 Book an appointment yourself (even by phone)
 Fill or prescribe medications (even by phone)
 Offer a specific treatment plan
 Have a conversation that’s not written in the record
w/in 30 minutes.
 Make decisions or actions based on individual doctor
production (for or against yourself) over patient care or
client service.


I have read the above procedure on Client Communication Guidelines. I understand and agree to follow
this procedure.

I also understand that if ANY doctor fails on any one of the three points listed above under doctor’s
personal phone the privilege of giving out cell phone numbers or talking to clients of Legacy Vet for
business purposes will be permanently removed for ALL doctors.



_________________________ _______________________________ ______________
Full Signature Printed Name Date


[37]

Drill/Quiz for “Client Communication Guidelines”:
1. Finish the sentence: If it’s not written, __ ______ ________.
2. Can you give your personal cell phone number? Are you required to?
3. Is it typically better to give out your cell #>
4. If you talk to a client via your personal cell phone, do you document it in AVImark? When? How
if you are not there?
5. What happens if any of the doctor cell phone rules are not followed, even once.
6. Should you give out your personal cell phone number so that a client stays with you and you
boost your production because they don’t see another doctor in our hospital?

































































[38]

1022.1 – Client Communication Scripts

Results Statement: To describe and recommend services in a way that is SIMPLE,
AUTHENTIC, EFFECTIVE and CONSISTENT among all staff.

Primary Responsible Positions: Technicians, Doctors

Participating Positions: All positions with client contact

First know what you’re talking about: “If you can’t explain it simply, you don’t understand it well
enough” - Albert Einstein










Should I memorize these? It is NOT necessary memorize every script word-for-word, BUT
you must hit the main points. This is necessary to give the
clients the same information from ANY LVH staff member.
These are not truly “scripts”! Each staff member will have their
own style and exact wording depending on that individual and
the situation. Each staff member must be able to communicate
these same messages comfortably in their own way.
In many cases actually memorizing these scripts exactly may
help you and save you time. You will know what’s best by
practicing.


WHERE These Scripts Fit: This is the “Education” portion of the “Client Compliance Tips”
procedure. It comes AFTER the “Feel, Felt, Found”.

WHAT to Say for Each Topic: Wellness or Early Detection Panels:
“Our routine blood panels check things on the INSIDE that
doctors cannot see on the outside. Hopefully everything will be
normal. If so, it will give baseline normal levels for your pet
every year.”

“If something is NOT normal it will give us a chance to fix it for
less cost and before your pet gets sick.”

(Demo Piece: Show an example lab report)


[39]

Heartworm/Flea/Tick Preventatives:
“Heartworms are EXTREMELY common in the DFW area. It’s
spread by mosquitos and is often deadly to dogs and cats.”

“Without heartworm prevention, almost all dogs in our area will
get heartworms. Treatment costs over $1,000 and takes
months with cage rest. There is no treatment for cats”.

“The cost for heartworm prevention is only around $10-20 per
month, even combo products with flea and tick prevention.”

(Demo Piece: Show heart model with heartworms and
brochure for recommended preventative)


Heartworm Tests:
“No heartworm preventative is 100% effective. If your pet has
heartworms we need to know this year, before 2 years go by
and there can be permanent heart damage. It also keeps your
guarantee on all heartworm preventatives we sell.”
(Demo Piece: Show a heart model with heartworms)

Fecal Tests:
“Our yearly parasite screen checks for worms that are ALL
contagious to you and your family. Pets get these from the
ground and dirty shoes or floors. No preventative prevents
everything. 15% of the pets we test have these parasites.”
(Demo Piece: Show the sheet of parasites we test for)

Distemper/Parvo Vaccine:
“Distemper and parvo are viruses that often causes death. They
are complicated and expensive diseases. They are common dog
viruses here in Frisco. This vaccine is guaranteed when given by
us at the correct times.”

(Demo Piece: Brochure titled “A Guide to Vaccines”)

Lepto Vaccine:
Lepto is a bacterial disease spread wild animals. It causes
kidney failure and is contagious to people. Dogs in the DFW
area get this disease every year.”

(Demo Piece: Lepto Brochure)








[40]

Bordetella “Kennel Cough” Vaccine:
“Kennel cough is a VERY common disease all over the country.
It’s like a cold for a dog. It’s spread through the air up to 20
feet. It frequently happens in dogs through fences and on
walks”

(Demo Piece: Brochure of “A guide to vaccines)


Receptionists Surgery Price Quotes:
Receptionists: It’s best to schedule the FREE pre-op exam (and
not quote a price) so the client can come in to get the exact
price. If they need a price by phone quote the BASE PRICE only.

“We need to schedule a free pre-op exam with one of our
doctors. They will get you the exact price for your pet along
with any other possible recommended services to make it as
safe as possible. What day works for you?”

(Demo Piece: See Phone Shoppers Procedure)

Higher Prices than the Client Expects or Is Used To:

See Client Compliance Tips: Use
“FeelFeltFoundEducationDemoFinance.

“I completely understand how that feels when the price is more
than you expect. We’ve had other clients that have felt the
same way. We have found clients appreciate hearing how we
focus on the safest care for your pet.”

Education & Demo: “We offer (services we do that is safer) to
avoid (possible problems).” Show appropriate demo pieces.

Finance: “The required services costs (base price). The
RECOMMENDED services cost (additional costs) extra.

(Demo Piece: Use Printed Treatment Plans AND Demo Models
as Applicable)














[41]

Drill/Quiz for “Client Communication Scripts”:
1. Before you get your trainer to discuss these go through each one practicing what you will say
and how WITHOUT looking at these scripts. These are important. Take your time learning these
until you truly understand them.
2. What happens if we didn’t know or follow these scripts? For the clients? For our staff?
3. Do you have to memorize every script word-for-word? Why or why not?
4. Go through each script with your trainer one at a time. Your trainer acts as the client. Explain
why your trainer should do what you recommend on each topic.
5. Get a pass only after you hit the points in less than 1 minute for each.


































































[42]

1023 – Client Acceptance Tips (CAT)


Results Statement: To help assure the health of pets by HELPING clients to
make informed decision and steps for their own pets.
When compliance is high the client saves time and
money. The pet is healthier. We get to do more of
what we love and be financially rewarded.



Primary Responsible Position: Associate Vet

Participating Positions: Technician and Client Coordinator

Overview: Unless certain steps are taken to allow the client to get
a full UNDERSTANDING of what we recommend and
how it HELPS THEM they will often decline. This way of
helping clients has proven to be the most effective and
efficient.

If, at any time during the process, the owner accepts
and says yes (make sure they know the cost before) to
our recommendations there is no need to go further
with explanations. This often happens with clients that
already trust us. If you continue to talk about it will
likely get more confusing and waste their time.

If a client LIKES you, they are more likely to listen. They
will know you like them by first listening and
understanding them. Use empathy (Feel, Felt, Found)
BEFORE education.

We are selling the invisible. Always use demonstration
pieces (pictures, models, results, etc). When a client
can see what they are paying for, it is easier to
understand how valuable it is.

















[43]

Compliance Steps to Take:

Before the client arrives:
1. STAY ON TIME or communicate unavoidable delays properly (see “Appointment
Delays”). A client that has been waiting too long does not want to hear about more
services and more expenses. They want to go home.
2. KNOW THE PET and their record. Review the records at least 3 appointments in
advance.
3. GET YOUR TEAM PREPARED: See “Appointment Flow and Staying on Time”.


When you FIRST meet with the client:
1. AUTHENTIC caring. Demonstrate to them that are truly here to help them and their
pet.
2. ASK QUESTIONS. Ask them what they may have concerns or questions about
BEFORE you tell them anything.
3. Address THEIR concerns first, not yours. Ease their mind with the reason THEY
came to us before you discuss anything else.


HOW to recommend:
1. “FEEL, FELT, FOUND”:
a. I know how it FEELS to have a sick pet and if it’s he/she is going to be okay.
b. I have FELT that with my own dog/cat.
c. I have FOUND it helped me to do this test to be sure it was not serious
2. EXACTLY WHAT AND WHY:
a. Explain exactly WHAT (specifically) and WHY you recommend something in
common grade school language. Big words will cause things to be declined
faster than most anything else.
b. Explain the consequences that will likely happen IF THEY DON’T DO THIS.
This is extremely important.
i. For example, if we DON’T do a dental cleaning it WILL get worse,
cause pain, cost more, may cause other diseases, and may shorten
their pet’s life.
c. THREE PARTS ALL CLIENTS NEED:
i. Education: Explain the reasons. How it helps THE OWNER and the
pet.
ii. Demo Piece/diagram: SHOW the client something, even if it’s hand-
written words. It could be a picture, model, brochure, etc.
iii. Finance: AFTER the above someone (non-Dr.) will discuss cost or
payments
3. MAKE IT SIMPLE FOR OUR CLIENTS: Offer the client and easy time and place to get
this done. All the client has to do is say yes. We will make it happen for them!








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Drill/Quiz for Client Compliance Tips:

1. Explain what is meant by “Feel, Felt, Found”.
2. What are the three parts we all need in order to recommend something.
3. If mid-way through your recommendation our client simply says yes should you continue to talk
about it? Why or why not?
4. With your trainer acting as a client go through the following three scenarios using the above
steps to help the client (your trainer) understand WHY they should do what you recommend,
even if they need to make payment arrangements.
a. Get the following demo pieces before starting: Knee model, report card, heartworm
model, laminated blood results.
b. A pet comes in limping in pain. We want to discuss X-Rays on the knee.
c. Dental cleaning on a grade 2 dental disease pet during an annual visit.
d. Heartworm prevention for a dog during an annual visit.
e. Wellness blood panel on an annual visit (early detection or senior wellness).






















































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1024 – Complications and Client Complaints

Results Statement: To create confidence and efficiency in handling client
complaints and complications with the care of clients’
pets. To handle those complaints with good listening,
empathy, and fairness.





Primary Responsible Position: Receptionists

Participating Positions: DVM’s, Client Coordinator, Execs, Techs, TA’s

Key Points:

 Complaints are our chance to IMPRESS! We all have had complaints about businesses. It’s how
the business listens and understands.
 Complaints are almost always caused by miscommunication or a lack of communication.
 Try to determine when or if WE may have failed to properly communicate.
 Complaints should be very RARE.
 ALL complaints should be reported to a manager so we can do everything to prevent them.
 Complaints should be understood enough that they ALL can be solved with common sense.
LISTEN!
 Resolutions should be fair to both the client and the hospital.
 Resolutions should be more in favor of keeping the client happy rather than us.
 If a client does not end COMPLETELY SATISFIED to the point they would refer their friends it is
dangerous to all of our jobs!




























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CLIENT Complaints:

What You Do:
 Look at the problem from the CLIENT’S point of view first.
 Don’t take complaints personally, even if a client makes a personal comment. It’s
not about you.
 Try to handle it at your level first.
 Use good judgment and that it is within reason.
 Receptionists have full authority to discount/refund UP TO $75 if it makes sense.
o Ex: If someone picks up their pet from grooming and are not completely
satisfied with the groom:
 See if the groomer can fix the cut and make them happy NOW
 See if we did not have a clear expectation on the grooming form
they signed. Did the client fully understand before signing? If not, it
is OUR FAULT. Refund the entire groom price. Assure the client will
give us another chance.
 Did we not have them fill out the grooming form completely? If not
refund the entire groom price.
 Did we do exactly what was written and understood on the
grooming form? If we did, then there probably would not be a
complaint!
 Anything OVER $75 needs to go to lead receptionist, other manager, executive,
DOCTOR, or owner.

What the Lead Receptionist Does:

 Lead receptionist has full authority to discount/refund UP TO $150 if it makes
sense.
 Anything OVER $150 needs to go to Director of Medical Services or an
exec….unless it’s over $150 AND it’s obvious.
o Try everything you can to solve the problem NOW. It’s the second biggest
priority we have.
o Let client know that you will have a manager follow up with them.
 Ex: If someone declines bloodwork or a treatment service during
their stay and it accidently gets done, that’s our fault and we can do
a discount for the treatment.


















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Complications in PATIENT CARE:

If we have a patient who has complications following medical or
surgical care we will handle it in ONE OF TWO ways:






1. If the complication is a result of OUR ERROR: The original service AND ALL remaining care to
correct this complication is completely free to the owner. Everything will be entered into the
patient record under the appropriate doctor with the regular prices then a “8052 Professional
Discount” is entered and the price is changed to a negative amount under the same doctor to
make the total charges as pertains to the complication are zero. Services unrelated to this
complication are charge at regular prices.

Examples:
i. A patient was given an injection overdose due to someone misreading or not
looking at the syringe.
ii. A patient was dispensed the wrong pills and had a reaction to the medication.
iii. A patient gets into a fight with another dog in our care because one of the dogs
was not on a leash in the hospital as required.


2. If the complication was NOT UNDER OUR CONTROL and there was no way of us knowing how
could have prevented it: The owner pays only for medications and products. We discount any
exam fees using the “8052 Professional Discount” as above.
Examples:
i. A patient has a suture reaction after a spay.
ii. A patient has a vaccine reaction to vaccines WE GAVE that we had no prior
history of.
iii. A boarder is vomiting despite us giving the proper care, food, monitoring, etc.

Note: On some occasions patients under our care are not responding to our treatment plans or are
getting worse even with our best efforts. THESE ARE NOT COMPLICATIONS AS DESCRIBED ABOVE.
These cases may require multiple exams, medications, etc, all at regular price.



















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Drill/Quiz on “Complications and Client Complaints”:
1. In your own words describe the results statement.
2. Why do we have the procedure? What would happen if we didn’t? How would that negatively
affect YOU?
3. Describe some key points of handling complaints and complications in care.
4. How much can YOU discount if it makes sense?
5. How much can the lead receptionist discount if it makes sense?
Describe the two basic types of complications in care. How do we handle each one?



































































[49]

1026 – Cryoprobe

Result Statement: To provide a cheaper and easier alternative to removing some small
masses without the need for sedation, anesthesia, or local anesthesia.

Primary Responsible Position: Associate DVM’s

Tips and How-To’s:

 Mass will not likely fall off during procedure
 Mass should fall off within 9-14 days.
 Recommend no-charge 10 minute recheck in 14 days.
 If during recheck follow-up excision is needed, we charge the “each
additional mass – cryoprobe”
 See the next page for details on how to load and use.























































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