Hospital Admission Release

Hospital Admission Release
I am admitting my pet with Animal Hospital of Pensacola to be examined by the veterinarians for symptoms listed:
Name

First NameLast Name
Symptoms:*
If the diagnostic procedure and/or treatment should exceed the estimate given or the following amount checked below, I understand that I will be notified by phone before any further procedures are performed. At that time, I may authorize or decline any additional diagnostic procedures and/or treatments.
$150.00$250.00$350.00Follow approved EstimateOther
If I cannot be reached at either the primary or secondary numbers listed below, I authorize or decline any further treatment until a future appointment and/or discussion.
AuthorizeDecline
In the event that your pet is hospitalized, our goal is to provide the best level of communication between the case veterinarian, hospital staff, and your family. We understand and appreciate the support which visiting while under our care does for her recovery. Visiting hours should be scheduled with your pets technician and/or treating doctor to ensure the veterinarian and technician assigned to your pet are available for consult during your visit.
Signature*

Clear
Date*

MonthDayYear
Date
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number*

Area CodePhone Number
Should be Empty: