Owner's Name:(Required)
Pet's Name:(Required)
Other than what our records show, does your pet have any medical history of the following:(Required)
Has your pet ever had complications with anesthesia?(Required)
Does your pet have any known allergies?(Required)
Has your pet taken any other medications in the past 5 days?(Required)
I approve for my pet to have bedding while staying at Johnston Animal Hospital and I verify my pet has not had problems in the past eating or chewing on bedding.(Required)
Addtional Optional Services(Required)
Rabies Vaccination Acknowledgement - In accordance with North Carolina law and for the safety of others, I acknowledge that my dog and/or cat must have a current rabies vaccination. If my pet has already been vaccinated, I agree to provide official documentation to Johnston Animal Hospital PRIOR to my pet's appointment, or authorize my previous veterinary provider to do so on my behalf. If I do not provide valid proof of current rabies vaccination before the appointment, I understand that: My pet will receive a rabies vaccine during the visit if the attending veterinarian determines it is medically safe to do so. I am responsible for any charges associated with the rabies vaccine. If the veterinarian determines it is not medically safe at that time, the rabies vaccine will be administered at a future visit when it becomes safe. I also understand that declining the rabies vaccine places me in violation of North Carolina law. In such cases, Johnston Animal Hospital reserves the right to refuse service, and my pet will not be seen.(Required)
I understand that Johnston Animal Hospital is not open 24-hours; therefore, if my animal is hospitalized or boarding overnight there will not be 24-hour supervision. If I desire 24-hour supervision of my animal, then I understand that I can request to transfer my animal to a 24-hour veterinary emergency or specialty hospital. I acknowledge that the responsibility for transporting my pet to the 24-hour emergency/specialty facility and the additional fees incurred for care at that facility would be my own.(Required)
I understand that if my pet has signs of fleas or ticks, the team at Johnston Animal Hospital will administer a dose of Bravecto to my pet. I understand that I will be charged an additional fee for this treatment.(Required)
I understand that if my pet has soiled themselves, the team at Johnston Animal Hospital will give a necessary freshening bath. I understand that I will be charged an additional fee for this treatment.(Required)
Pre-Anesthetic Blood work(Required)
Pre-anesthetic blood work is used by the doctor to evaluate organ function and metabolic function before anesthesia. Understanding blood work values helps the doctor to determine the safest anesthetic choice(s) for your pet. The cost of the blood work will be included in your pet's Health Care Plan.
Life-Saving Emergency Care(Required)
I understand that all procedures will be performed to the best of the abilities of the team at Johnston Animal Hospital. However, I accept that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results. Select ONE option below for your pet so we can be prepared in an event that life-saving emergency care is needed:
I certify that I am the owner, or authorized agent for the owner. I hereby consent to and authorize the doctors and team of Johnston Animal Hospital to admit this pet and perform the procedure indicated on this form. I understand I will be given a health care plan to review at the time of my pet's admission to Johnston Animal Hospital. I acknowledge that I am responsible for payment in full for the procedures and treatments at patient discharge.