Day Admission Form Day Admission Form Name(Required) First Last Primary Phone Number(Required)Secondary Phone NumberPet Name(Required) Pet Name Date of Appointment(Required) MM slash DD slash YYYY Consent(Required) I agreeI certify that I am the owner of the above named pet and am agreeing to drop off my pet at Singing Hills Animal Hospital for the purpose of examination. I understand that, at minimum, I will be held responsible for an exam fee of $68 and a day admission fee of $23. Please choose the option that best applies with regards to diagnostic testing and/or treatment.(Required)I wish to be contacted prior to any diagnostic testing or treatment.I consent to having diagnostic testing and/or treatment performed as deemed necessary by the doctors at Singing Hills Animal Hospital as long as it does not exceed total procedure cost expectations. Should the doctor's recommendations exceed this amount, please contact me first.Please enter your Total Procedure Cost Expectations(Required) We will contact you if recommended testing/treatments exceed this amount.Reason for today's exam(Required) How long has this issue been occurring?(Required) What symptoms has your pet been displaying?(Required) Vomiting Diarrhea Loss of appetite No bowel movement No urination Coughing Sneezing Increase in thirst Decrease in thirst Lethargic Other Please check all that apply.Other symptoms(Required) Please describe any other symptoms your pet is experiencing that are not listed aboveDoes your pet have any allergies?(Required)YesNoPlease list your pet's allergies(Required) Is your pet on any medications?(Required)YesNoPlease list the medications your pet is currently taking.(Required) Signature(Required)
