Forms Day Admission | Mill Creek Animal Ho

Day Admission Form

We’re glad you’re here! To help us take the best care of your pet, please leave them with us so the doctor can examine them as soon as possible today. We’d appreciate it if you could take a moment to read through the following questions and answer them as best as you can. Thank you!

Date

Month

Day

Year

First name

Last name

Phone

Patients Name

What is the reason for today's visit?

How long have the symptoms been present?

Is your pet on any medications regularly or have you given any over the counter medications recently?

Is your pet eating and drinking normally?

Has there been any vomiting, diarrhea, coughing or sneezing?

What diet does your pet eat?

When was the last time your pet ate?

Does your pet go to the groomer? Board anywhere?

Does your pet go to dog parks or hiking/camping?

How is your pet feeling/behaving?

Is your pet on prevention for fleas, ticks, and heartworms? If so, what kind and when was the last dose?

Do you have any other concerns?

I hereby agree to indemnify and hold Mill Creek Animal Hospital harmless from any and all liabilities arising from the procedures outlined above. I acknowledge that sedation and/or pain medication will be administered as deemed necessary to ensure the well-being of my pet. Furthermore, I understand that full payment is expected upon my pet's discharge. By signing this, I affirm my commitment to these terms and the care provided.

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