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Hospital Admissions Form
Please Note: If this is the first time we are seeing your pet a New Client Registration Form is also required.
Owner's Name
*
First
Last
Pet's Name
*
Species
*
Age:
*
Please indicate the reason for your pet's drop off/hospitalization:
*
Preventative Care (ex; vaccinations)
Urinalysis
Blood Work
X-Rays
Illness
Injury
If illness or injury, please describe:
Additional comments or concerns?
When was your pet's last meal?
*
Today AM
Today PM
Yesterday AM
Yesterday PM
What medications (if any) has your pet received in the last 24 hours? (please list the name, amount, and time given):
All pets admitted to our practice must be current on their Rabies vaccination.
*
My pet is current
My pet is NOT current
A written estimate of anticipated fees has been given/ will be provided to me upon my request. A deposit may be required upon admittance to the practice. I understand all charges shall be paid in full at the time of discharge. By signing below you give American Veterinary Hospital permission to proceed with any diagnostics testing and/or procedures, including sedation, recommended by the Veterinarian.
*
I agree.
Our practice is to use all reasonable precautions against injury, escape, or demise but will not be held liable or responsible in any manner regarding the care, treatment or safe keeping of the animal.
I understand that I am assuming all risks involved in care and treatment for this animal.
*
I agree.
I consent to administration of anesthesia as deemed necessary by the doctor.
*
I agree.
I acknowledge that risks and the possibility of complications exist in any surgical or medical treatment.
*
I agree.
In admitting my pet(s) for diagnostics, treatment, or procedures, I hereby consent and authorize American Veterinary Hospital to receive, treat and prescribe as deemed necessary.
*
I agree.
Home
Client Center
New Clients
Office Tour
Kids Corner
Purina Diet Home Delivery
Online Pharmacy
Specials and Promotions
Testimonials
About Us
Our Hospital
Our Team
Policies, Procedures & Payment Options
My Pet
Pet Services
Boarding
Drop Off Services
In Home Pet Euthanasia
Pet Hospice Care
House Calls
Veterinary Emergency
All Services
Pet Health
Pet Health Resources
Interactive Animal
Breed Info
Videos
Pet Health Checker
News
Contact Us
Location / Hours
Make An Appointment
Gift Certificates
Pet Health Savings Plan
Affordable Vaccine Clinic
Affordable Vaccine Clinic
Packages & Additions
Clinic Dates
Payment Options
FAQs
Resources