Admit Form

Please take the time to fill out this form completely. Since you will not be present the entire time your pet is in the hospital it is important for our doctors to have this information about your pet.
  • Basic Info

  • please be specific
  • Pet Health History

    Please circle if your pet is currently having any of the following:
  • include amounts and any treats given
  • including supplements and over the counter medications
  • Fees*

    Admittance to hospital ($27.50) + Exam fee ($93.50) +/- Urgent Care fee ($60.50).
    Examples of other common fees: Blood work $175.50 and up, Urinalysis $82, Radiographs $531.50 and up, Fluid therapy $73.50 and up
  • In situations where your pet may be ill it is important to start treatment as soon as possible. Any treatment fees will be in addition to the exam and hospitalization fees for the admit appointment. Please initial one of the following:
  • Or
  • Authorization

    I hereby authorize the veterinarians of Eastside Veterinary Associates to examine, prescribe for, and treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I understand these charges must be paid at the time services are rendered and that a deposit is required for hospitalization or surgical treatment.