Medical Treatment Admission Form | Veterinary Hospital Group

Section A - General Details Which Vet Hospital clinic do you attend:

CatDogOther

Section B - Treatment DetailsPlease briefly describe what has been happening with your pet that has led you to seek veterinary careHas a treatment plan for your pet been discussed with you

YesIf no, continue to next question

Does your pet have any food/drug allergies?

YesIf no, continue to next question

If yes - please detail.What is your pet's usual diet?Is your pet currently receiving any medication?

YesIf no, continue to next question

If yes - please detail.Section C - Treatment Plan EstimateHave you been provided with an estimate of treatment plan costs?

YesIf no, continue to next question

Please note: Estimates include anticipated costs for the day of your pet’s initial care. Rarely, complications may occur which cannot be anticipated and are not included in the above estimate. If any of these unforeseen circumstances occur you will be contacted as soon as possible to discuss any potential additional charges.

Section D - Treatment complicationsMedical treatment is usually very safe and complications are rare. However adverse drug reactions or injury during treatment can occur. If you have further questions regarding potential complications please contact your veterinary team to discuss them.

I understand the potential complications for my pet and have no further questions

Section E - Consent to carry out veterinary treatmentI, being the owner, or an authorised agent, of the above pet hereby authorise the Veterinary Hospital Group to perform the discussed diagnostics and treatment for my pet. I agree to pay for these services and have been given the opportunity to ask questions regarding my pet’s care.

I consent to the agreed treatment for the pet described above

Thank you! Your submission has been received!

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Medical treatment admission consent