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Registration / Check-In Form
This form is for scheduled patients.
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Anesthesia / Surgical Consent

Please read and mark to acknowledge the following information regarding your pet's care:
Reason for visit:
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 exam is required prior to any anesthesia if longer than 30 days since your last visit. However, this may not identify all systemic or metabolic problems. For this reason, Cornerstone Animal Hospital recommends ALL pets have a pre-anesthetic blood panel to evaluate major organ function prior to their procedure.

I would like pre-anesthetic bloodwork performed on my pet. (around $150) 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 anesthetic mortality than other domestic species. Sedation is sometimes required to minimize stress during handling, reduce the risk of injury, and/or aid in the acquisition of diagnostics. 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? Any changes in weight/appetite/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? *

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In a survey carried out by the Association of Veterinary Anesthetists (AVA), exotic animals have a much higher clinical anesthetic mortality than other domestic species. Sedation is sometimes required to minimize stress during handling, reduce the risk of injury, and/or aid in the acquisition of diagnostics. 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.
Rabbit owners: In an effort to prevent the spread of fatal disease, Cornerstone Animal Hospital requires all rabbit patients be vaccinated for RHDV2 as deemed appropriate by our veterinarian. *

I understand that my rabbit may be vaccinated during our visit and I am responsible for the cost ($33).
Dog and Cat owners: *Our State Rabies Law requires owners to maintain up-to-date rabies vaccinations, and does not allow veterinarians to approve any titer or medical exemptions. All day-admission, surgery, or drop-off appointments require proof of a current Rabies vaccine, and if *

I understand that if I am unable to provide proof of a current vaccine, Cornerstone Animal Hospital may require a Rabies vaccination (if deemed appropriate at the time of visit), and I am responsible for the costs incurred for my dog ($25) or cat ($30).
I, the owner or agent, am at least 18 years old and accept responsibility for decisions regarding 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.
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Registration / Check-In Form

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Examination Questionairre

Anesthesia / Surgical Consent

Recheck/Follow-Up Appointment Questionairre