Client Registration and Patient Information

Registration / Check-In Form
This is specifically for patients with an upcoming visit.

(Completing this WILL NOT create/request an appointment!)

Thanks for taking the time to fill out this form prior to your visit! It should only take a few minutes, and helps us provide the best care possible.

Anesthesia / Surgical Consent

Please read and mark to acknowledge the following information regarding your pet's care:
Reason for visit:
Did you bring any belongings?
Did your pet eat breakfast this morning?
Please list any and all medications your pet is currently taking. What was the last dose given (if any?)
Any questions or concerns for your veterinarian today?
I understand that Cornerstone Animal Hospital will discuss my pet’s treatment plan prior to any sedation or anesthesia, if warranted. Some risks always exist with sedation, and I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before any procedures are initiated. While I accept that all services will be provided to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved.

The attending veterinarian will make every effort to contact me regarding treatment of my pet in the event of any unforeseen emergencies. If Cornerstone Animal Hospital is unable to contact myself or the assigned agent, I consent to life sustaining procedures unless otherwise requested and accept all associated charges.

I accept full responsibility for any additional expenses that may be incurred for continued treatment, such as follow up radiographs, re-check physical exams and additional procedures due to complications. It is important to note that these are more likely to occur when there is a failure to comply with the recommended instructions.
I understand that an examination is required prior to any anesthetic or surgical procedure if it has been longer than 30 days since the last appointment. However, this may not identify all systemic or metabolic problems. For this reason, Cornerstone Animal Hospital recommends my pet have a pre-anesthetic blood panel to evaluate major organ functions prior to anesthesia.

I would like pre-anesthetic bloodwork performed on my pet. ($147) My pet's pre-anesthetic bloodwork was previously completed (within 6 weeks). I decline screening bloodwork prior to anesthesia.
In a survey carried out by the Association of Veterinary Anesthetists (AVA), exotic animals have a much higher clinical mortality associated with anesthesia than in other domestic species. Sedation is sometimes required to minimize stress during handling, reduce the risk of physical damage, and/or aid in the acquisition of samples for diagnostics. I understand I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the use of any sedation. *

I understand and acknowledge the information set forth above.

Recheck/Follow-Up Appointment Questionairre
Do you feel that the problem is better or worse?
Have you noticed any changes in weight, appetite or thirst?
Any new questions or concerns you would like your Veterinarian to know since your last appointment?
Is your pet currently on any medications - if so, have you been able to administer them successfully? Do you need any refills?

Do we have your permission to use photos of your pet(s) for education, social media, or other marketing purposes? *

Yes No
In a survey carried out by the Association of Veterinary Anesthetists (AVA), exotic animals have a much higher clinical mortality associated with anesthesia than in other domestic species. Sedation is sometimes required to minimize stress during handling, reduce the risk of physical damage, and/or aid in the acquisition of samples for diagnostics. I understand I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the use of any sedation. *

I understand and acknowledge the anesthetic risks.
I, the owner or agent of the pet identified, am at least 18 years or older and accept responsibility for decisions in regards to this pet's medical care. By entering my name in the Electronic Signature field below, I understand that I am responsible for all charges incurred in the care of my pet. I understand that Cornerstone Animal Hospital requires payment in full at the time of service and that a deposit may be required. *

I have read and fully understand the Terms and Conditions.
Signature

Clear
Printed Name *
Current Date *
Should be Empty:

Registration / Check-In Form

Your Information

Examination Questionairre

Anesthesia / Surgical Consent

Recheck/Follow-Up Appointment Questionairre