Day Admit Form

Owner’s Name(Required)

First

Last

Phone Number(s) where you can be reached TODAY(Required)

Pet's name(Required)

Your Pet’s Age(Required)

Weight(Required)

Is your pet Male or Female?(Required)

Male

Female

Does your pet have insurance?(Required)

Yes

Who is your insurance provider?(Required)

Is your pet on any medications currently? If so, please list all medications and frequency given:(Required)

Is your pet given consistent MONTHLY preventative medication? (Heartworm and Flea)(Required)

Is your pet allergic to anything? If so, please describe:(Required)

Has your pet had any illnesses or seizures in the past? If so, please describe:(Required)

Has your pet been given any food or medications today?(Required)

If your pet needs to be given any medications at home, which to you prefer to give?(Required)

Liqui

Pills/Tablet

Requests(Required)

Physical Examination

Diagnostics recommended by Doctor (if needed): Xrays, Bloodwork, Ultrasound, etc

ACTH Stim Test

Blood Glucose Curve

Bath/Medicated Bath (For cat baths, Sedation or Anesthesia may be required)

Nail Trim

Anal Gland Expression

Brush Out/Furminated

Vaccinations / Testing

Rabies

Distemper/Parvo

Bordetella

Lyme

Lepto

Influenza

FVRCP

Leukemia

Heatworm Test

Fecal

Bloodwork Panel

I agree:(Required)

All pets that stay with us for Boarding are required to have current vaccinations; Rabies, Distemper, and Bordetella (every six months). Also, all pets must be free of contagious parasites such as fleas, ticks or gastrointestinal worms. We will treat your pet for any parasites that will affect other animals in our care and you will be charged for these services.

IN THE EVENT OF A MEDICAL CRISIS:

In case of CPR needed:(Required)

I wish for the doctors of the Veterinary Clinic of Myrtle Beach to perform CPR on my pet if he/she suffers respiratory or cardiac arrest. I understand that my pet may or may not respond to this life-saving procedure. I understand that if my pet survives because of CPR, he/she may have permanent health issues. CPR may cost up to $300

I DO NOT want CPR performed on my pet. I understand that if my pet stops breathing, and/or his/her heart stops beating, that my pet will die. I elect to have DNR orders placed on my pet’s record for his/her boarding stay.

Owner’s Signature(Required)

Phone

This field is for validation purposes and should be left unchanged.