Emergency Admission Form

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We have this form available online for your convenience, allowing you to complete the form and have it ready at the time of your arrival at our hospital, if desired. If you prefer to print the form and bring the completed version in, please click ‘download’ below.

Client Information (must be 18 or older)
Pet Information
Hospital Financial Policy
Payment is due at the time services are rendered. Please be advised that the emergency examination fee is $87.
Recommendations for additional diagnostic and treatment procedures will be presented with a written estimate of cost. If hospitalization is elected, 100% of the lower end of the estimate will be due at the time of admission. Payment in full is due at the time of discharge. We accept cash, all major credit cards (Visa, Mastercard, Discover, and American Express), CareCredit, and checks (which are processed electronically via Telecheck).
We understand that visiting the emergency hospital with your pet can be a stressful experience. We realize treatment costs may be more expensive than anticipated due to the nature of your pet’s medical condition. If you have any financial concerns or questions about our policies, do not hesitate to ask the receptionist or nearest customer service representative.
Authorization and Request for Services
By signing below I authorize the doctor to assess my pet. I understand that payment in full is due at the time services are rendered. I assume responsibility for all charges incurred in the care of this animal. If my pet requires admission into the hospital, I understand that emergency veterinary care is not intended to be a substitute for complete veterinary care.
Must be 18 years or older