Patient Admission Form--Annual

Patient Admission Form

Gregg Animal Hospital
Date

MonthDay Year
Date
Name

First Name Last Name
Pet's Name

First Name Last Name
What is the best number for us to contact on the day of your pet's appointment? Please have voicemail activated on your phone.*

Area Code Phone Number
Email*
example@example.com
All dogs must be brought on a leash, and all cats must be brought in a carrier.

If you are dropping off your pet, please make sure you are available by phone so the team can reach you with any questions after the exam. We are open Monday-Friday 8:00 a.m.-6:00 p.m. Once the doctor has contacted you to let you know your pet is ready to go home, they must be picked up before close or they will incur an overnight boarding fee.
Please provide stool and urine samples at the time of drop-off or appointment. Both samples must be refrigerated within 30 minutes of collection; stool samples must be less than 8 hours old, and urine samples must be less than 12 hours old. We cannot accept urine samples in paper towels, litter, etc. We must be able to draw the urine up into a syringe.
If fleas are found on your pet, we reserve the right to treat for fleas in-hospital. We will administer a CapStar tablet orally in the event that fleas are found.
By clicking here, you agree and understand that your pet must be up-to-date on all required vaccinations in order to be dropped off. For cats: rabies, FVRCP. For dogs: rabies, distemper-parvo (dhpp), and bordetella (kennel cough). If your pet is not up-to-date, the required vaccination(s) will be updated at this visit at the veterinarian's discretion.*

Yes, I agree
Would you like us to call if any treatments that go beyond annual services are recommended?

YesNo
If this is your pet's first visit with us, what is the name of their previous vet? Have they had vaccines before? If so, please list.
What concerns do you have for your pet that you would like the doctor to know?*
Is your pet having any of the following? Check all that apply.

CoughingSneezingVomitingDiarrheaWeightlossWeight GainDecreased appetiteDecreased energy levelIncreased water intakeIncreased urination
If yes to any of the above, please provide a brief description.
Is your pet on heartworm prevention? Name of product?*
Is your pet on flea prevention? Name of product?*
Is your pet on any daily medications (y/n) ? If so, please list name(s) of medication(s), strength, and last time you pet received any medication(s).*
Does your pet need any refills of any current medication or prescription diet food? (e.g. heart worm and flea prevention or*

YesNo
If yes, please list any medications that need refilling.
Is your pet mainly indoor or outdoor?
What type of food do you feed you pet? How much do you feed?
Our doctors recommend annual lab work for dogs and cats. Junior Wellness testing is recommended for animals 7 years and younger. Annual Comprehensive Wellness is recommended for healthy animals 8 years and older. We believe that preventative medicine is extremely useful. Checking baseline lab work in an adult or senior pet, even if outwardly healthy, can not only verify that a pet is truly healthy, but in some cases can shed light on a possible underlying medical condition for which the pet is not yet showing symptoms.

Please note that if you pet is sick or injured, the doctor may want to run different diagnostics for better medical assessment.

Please note the prices below are only for the wellness lab panels themselves and do not include the cost of the exam or any other services rendered during the appointment.
Please run Junior Wellness for my pet who is 7 years and younger ($96.00):*

YesNo
Please run Annual Wellness for my pet who is 8 years and older ($187 for dogs; $196.50 for cats due to the inclusion of Free T4 for early detection of hyperthyroidism): (please note that this panel is valid for annual appointments only)*

YesNo
I have read and understand that if I selected "yes" to either of the above, I am aware of and responsible for their respective additional charges.*

Yes
Would you like your pet to have any additional services today such as a nail trim/anal gland expression/etc.?
Signature*

Clear
Please verify that you are human*
Should be Empty: