Forms

Need to complete a new client or surgery consent form? Save yourself the paperwork at our hospital and use our convenient online forms instead.

Client Forms for Registration, Surgery, and Drop-Off: Cat Laying On Bed

New Client Form
Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Employer Address
Employer Address
City
State/Province
Zip/Postal
Employer's Address
Employer's Address
City
State/Province
Zip/Postal
How did you hear about Animal Care Hospital?

Please note: Your privacy is important to us. 
All information received in all forms and through other communications is subject to our Patient Privacy Policy. 

Pet Information

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Sex

All payments are due at the time of services rendered.

I have read and understand the above statements and agree to all terms therein.

Anesthesia & Surgery Consent Form
Name
Name
First
Last
Feline
Canine
Medical History - Does your pet have any of the following? Please check all those that apply.

Dogs

Tested for Heartworm disease within one year?
Current on Heartworm preventative and immunizations? (DA2LPPVO, Rabies, Upper Respiratory/Bordetella)?

Cats

Tested for Feline Leukemia and Feline Immunodeficiency Virus (Feline AIDS)?
Current on Immunizations (FVRCP-C, Rabies)?

Surgical and Anesthetic Safety

As with any surgery requiring general anesthesia, there are certain risks that serious complications or even death may result. To minimize the risk of such occurrences, we provide the following additional anesthetic safety procedures. 

Today we will be performing a chemistry and CBC blood panel to assure proper organ function, clotting ability, detect anemia or infection, provide a baseline for future reference. We require pre-surgical bloodwork on all of our surgery patients, regardless of age, to maximize safety. If you choose to decline, you indicate that you understand the additional risks involved.
Home Again Microchip ID, Permanent identification recognized worldwide. $55 with surgical procedure.
Pain medication will be sent home with your pet.
In the event that we are unable to contact you during the procedure, do you authorize us to proceed with extractions or other recommended services during anesthesia?
I am aware of the risks involved with anesthesia and surgery, including possible death or permanent, irreversible injury, and understand the information presented in this surgery form and give Animal Care Hospital permission to proceed with the surgery and to perform any and all life-saving procedure should the need arise. Further, I understand that I am financially responsible for all costs incurred during the surgery, treatment, and hospitalization.
Do you have texting at this number?

Drop Off Consent Form

(To be filled out after scheduling drop-off appointment)

Name
Name
First
Last
My pet is lethargic
Water intake has
My pet started vomiting
My pet has normal stools
My pet seems constipated
My pet started having diarrhea
Has your pet had access to foods other than recommended pet food?
My pet has
My pet is
It has
This has

Boarding Consent Form

(To be filled out after scheduling boarding appointment)

PLEASE CALL TO CONFIRM AVAILABILITY BEFORE FILLING OUT THIS FORM. THIS FORM IS TO BE FILLED OUT AFTER SCHEDULING A BOARDING APPOINTMENT.
Name
Name
First
Last
Please check the following behaviors that your pet may exhibit
Feeding
I wish for my animal to receive:
*Please note that any pet found to have fleas upon check-in will be treated at the owners' expense

HURRICANE SEASON (June 1st-November 30th)

In the event of any mandatory evacuation or in the event of tropical storm warning, all owners will be called and asked to be on stand-by. Should a Hurricane Warning be posted, all pets are to be picked up within 3 hours of such notice. If the pets are not picked up, they will be transported to a safer location in an air-conditioned van at the owner's expense.

As a courtesy reminder, CHECK OUT TIME FOR BOARDING IS 10AM. Any pets departing after 10am will be charged for that days boarding. Pets are welcome to stay as late as 6:00PM.

I agree to the above terms and conditions

In the event of an emergency please contact me by:

I would prefer to get my pet's pictures sent to me while boarding via