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Home
Our Hospital
Our Team
Hospital Tour
Forms
New Patient Registration Form
Day Admission Form
Boarding Admission Form
Acupuncture Form
Feline Wellness Questionnaire
Canine Wellness Questionnaire
Anesthetic Consent Form
Operating Hours Disclosure
Veterinary Resources
Careers
Why AAHA Accreditation?
Services
Wellness Exams
Vaccinations
Spay & Neuter
Microchipping
Dental Care
Surgery
View All Services
New Clients
Payment & Insurance
Insurance options
Payment Options
Shop Online
Contact Us
Make an Appointment
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Day Admission Form
Day Admission Form
IN PATIENT AUTHORIZATION
Owner's Name
(Required)
Pet
(Required)
Date of Appointment
(Required)
MM slash DD slash YYYY
Reason for visit
(Required)
Please indicate if you have any medications needing to be filled or refilled
(Required)
LABWORK/TESTING
Please select the applicable labwork/testing your pet might need.
Which labwork/testing is your pet needing?
X-Rays
Ultrasound
Lab Work
Urinalysis
Cytology
May we sedate your pet (only if absolutely necessary)
(Required)
Yes
No
YEARLY VACCINES/TESTING
Your pet may also be due for one or more of the following:
Feline
FDRC
Rabies
Leukemia
Baseline Lab Work
Canine
DHPP
Rabies
Bordetella
Leptospirosis
Lyme
Canine Influenza
Heartworm Test
Baseline Lab Work
Fecal
Would you like to add any additional services at the time of your visit? (i.e. nail trim, anal gland expression)
(Required)
YES
NO
Additional services needed
CPR or DNR Consent
CPR
means
C
ardio
P
ulmonary
R
esuscitation and is the treatment or resuscitation of a pet who has stopped breathing or whose heart has stopped beating. Resuscitation of a pet who has stopped breathing but still has a heartbeat is more likely to succeed than resuscitation of a pet with no heartbeat.
CPR Consent
(Required)
Accept
Decline
Owner Initials
(Required)
DNR
means
D
o
N
ot
R
esusicate. This means if a pet stops breathing or the heart stops, no effort will be made to attempt to revive the pet, and the pet will die.
DNR Consent
(Required)
Accept
Decline
Owner's Initials
(Required)
AUTHORIZATION
To prevent the spread of infectious diseases and parasites, all animals staying in the hospital must be current on all
vaccines and free of internal and external parasites. Vaccines and parasitic control will be administered as deemed
necessary by the doctor. The doctors and staff are to use all precautions against illness, injury, and circumstances on
account of the care, treatment, or safe keeping of my pet(s), as it is thoroughly understood that I assume all risks.
I am the owner/agent of the pet described above and give permission to perform the services listed above.
Full Name
(Required)
Contact number
(Required)
Signature
(Required)
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