Day Admission Form

Please choose one option below to help us efficiently care for your pet in a timely manner.

PLEASE NOTE: Once admitted to the practice- a $60.00 Medical Exam Fee will be applied to your invoice

• An estimate will be provided to me upon my request.
• A deposit may be required prior to services being rendered
• I understand I am responsible for all charges incurred and payment is due upon release of my pet.
• I understand the medical exam performed on my pet once admitted to the hospital is a $60.00 fee that is already an incurred charge

• Any pets staying in the hospital, for any reason, are required to be free of fleas, ticks, or any other external parasites. If the staff finds any parasites on your pet, we will administer parasite control at the owner’s expense.
• Our practice is to use all reasonable precautions against injury, escape, or demise but will not be held liable or responsible in any manner regarding the care, treatment or safe keeping of the animal. I understand that I am assuming risks involved in care and treatment for this animal.

• Every effort is made by our practice to ensure the safety of the medical procedure when using sedation/anesthesia. I acknowledge there are always risks involved and the possibility of complications in any procedure.
• In the event of my pet should go into cardiac/ respiratory arrest (heart stops/ stops breathing)

During the day, it is important that our hospital is able to immediately reach the owner/ authorized agent responsible for making both health care and financial decisions. The undersigned is that agent.

In admitting my pet(s) for diagnostics, treatment, or procedures, I hereby consent and authorize American Veterinary Hospital to receive, treat and prescribe as deemed necessary.