Our Goal Is To Make Your Pet Happy!

SEMINOLE TRAIL

ANIMALHOSPITAL

        Admitting Form

All animals must be free of external parasites (fleas/ticks) when admitted; or must be treated upon admission for an additional charge.  All dogs must have current immunizations against Rabies, Distemper, Parvovirus, Bordetella, Canine Influenza, and a negative Heartworm test.  All cats must have current immunizations against Rabies, Distemper, Rhinotracheitis, and Calicivirus.  All animals must have had a fecal examination for internal parasites within the last 12 months.

Some pets require sedation for adequate physical exam, treatment, surgery, or dentistry.  May we sedate your pet if necessary?  Yes No Call first.  After examination by Dr. Williams, may we proceed with tests/treatment?  Yes No Call first

 

Personal Belongings_______________________________________________________________________________

I understand that the clinic is not responsible for loss or damage to personal items left with the pet including but not limited to leashes, collars, toys, and bedding.

 

Is your pet on heartworm preventive? Yes No    Flea/tick prevention? Yes No Checked for intestinal parasites in the last 12 months? Yes No

Has he/she had any vomiting, coughing, sneezing, diarrhea, illness or injury in the past 30 days? ________________________________

 

*I understand you cannot guarantee the health of my animal.  I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limited to weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea, and fleas.  *I understand all pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owner / agent’s expense.                                                                                                                                           

*I understand that in the event of  my pet’s illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options, but may not be able to contact me immediately and is therefore authorized to initiate appropriate treatment until or my agent can be reached.

*Should an EMERGENCY arise, I authorize the medical staff to treat my pet and/or perform such emergency procedures as may be necessary for the health of my pet until I can be notified.  I agree to pay, in full, all charges for necessary services rendered for and to my pet.

*The clinic is to use all reasonable precaution against injury, escape, or death of my pet.  The clinic and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed.  I understand that any problem that develops with my pet will be treated as noted above and I assume full responsibility for the treatment expense incurred. 

*All financial obligations must be satisfied with the business office before my pet is dismissed from Seminole Trail Animal Hospital.

 

Date:  ___________________ Owner / Agent: __________________________________________________________________________

Text Box: Name & Phone Number of Responsible Party to be reached in an Emergency__________________________________________________

Patient:

Admitting Date: _________Pick Up Date: _________AM   PM  Admitting Wt: ____

Admitting Date: _________Pick Up Date: _________AM   PM  Admitting Wt: ____

Admitting Date: _________Pick Up Date: _________AM   PM  Admitting Wt: ____

Dismissal Bath at ADDITIONAL CHARGE: YES  NO Date:_______

 

Dismissal Bath at ADDITIONAL CHARGE: YES  NO Date:______

 

Dismissal Bath at ADDITIONAL CHARGE: YES  NO Date:_______

 

Medical Services REQUESTED AT ADDITIONAL CHARGE: __________________________________________Date___________ Tech: ____

Medical Services REQUESTED AT ADDITIONAL CHARGE: __________________________________________Date___________ Tech: ____

Medical Services REQUESTED AT ADDITIONAL CHARGE: __________________________________________Date___________ Tech: ____

 

Medication Administration Times/Day__________________________________

 

Is your pet allergic to any drugs?    What?  ________________________________

Are we feeding our food or Owner’s food? Special Feeding Instructions AM  PM  SID BID:  _____________________________________________________________________

Be aware that the diet may vary while here, if you do not bring your own food, and your pet may bark at other animals.  This can create problems such as a sore throat, tonsillitis, or diarrhea.  We seek to prevent such problems, but please understand that these problems do develop.  Owners will be charged the appropriate fees for all treatment and medication needed for reasons that are not directly under our control.

 

Owner:    

Phone:

Street:

City:

Email:

 

I will call if my “pick-up date” changes so you can plan accordingly.

 

 

After Hours Pick up Information:

 

Date: _______ Phone: __________

 

 

Date: _______ Phone: __________

 

 

Date: _______ Phone: __________

 

 

PLEASE ASK ABOUT OUR CANCELLATION POLICY!