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*
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*
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*
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*
Reason for being seen today:
*
Vaccine(s)
Recheck
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Other
How is your pet doing today?
*
Medications
Not on any medications
Yes, list medications below
Medication Name
Last Time Given - Please indicate AM or PM
Feeding Information
Diet Fed
*
Approximately how much do you feed your pet per day
*
Approximately when is the last time your pet has ate any food or treats
*
Please indicate any food allergies:
Authorization
Should any unforeseen procedures be necessary and indicated in the veterinarian’s professional judgment, please select one of the following options:
I prefer that you proceed with all necessary procedures.
I prefer to be called before any additional procedures. If I cannot be reached, I DO authorize you to proceed with any procedures as deemed necessary by the doctor.
If I cannot be reached by phone, I DO NOT authorize you to proceed with any additional procedures. I am satisfied after speaking with the staff of Frey Pet Hospital that they will treat
as they deem necessary for his/her health, safety, and well-being; however I do understand that no guarantee of successful treatment can be made. I acknowledge that I have read and fully understand this Authorization for Medical Treatment, the reason why such medical treatment is considered necessary, as well as, its advantages and possible complications, if any. I acknowledge that a small area of hair may be shaved in order to obtain a sample.
The best number I can be reached at:
*
Consent
*
I have received an estimate for the procedure. (If you have not, please ask for one now!) I understand that payment is due at the time of my pet's discharge and that a deposit may be required for extensive medical or surgical procedures.
Electronic Signature
*
I Agree
By checking this box you agree to the information and terms listed on this form and confirm them to be accurate to the best of your knowledge.
Date
*
Date Format: MM slash DD slash YYYY
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*
New Clients
Make an Appointment
New Client Registration
What To Expect
About Us
Our Location
Our Team
Philanthropic Philosophy
Photo Gallery
Virtual Tour
Fear Free
Services
Additional Services
Breeding Services
Health Screening Tests
Medical Services
Patient Monitoring
Surgical Services
Wellness & Vaccinations
Preventative Services
Advanced Treatments
Advanced Surgery
Laparoscopic Surgery
ACL Repair
Cancer Treatment
Diagnostics
Laboratory Diagnostics
Ultrasound and Echocardiogram
Endoscopy
Laser
Surgical Laser
Therapeutic Laser
Pain Management
Stem Cell
Platelet Rich Plasma
Radiology
Digital Radiology
Digital Dental Radiology
What is AAHA?
Pet Health
Pet Health Checker
Pet Health Library
Resources
Links
Pet Memorials
Pet Stories
Pet Story Submission Form
Pharmacy