Treatment Admission (PDF)
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New Client/Patient Form (PDF)
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Feline Behavioral History Form (PDF)
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Canine Behavioral History Form (PDF)
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New Client / Patient Form

Welcome to Inman Park Animal Hospital. Please take a few minutes to fill out this form as completely as you can. If you have any questions we will be glad to help you. We look forward to working with you in maintaining your pet’s health.

OWNER INFORMATION:

Dr.Mr. Mrs.Ms.

*Last Name:

*First Name:

Address:

County (check one)

FultonDekalbOther county

City:

State:

Zip:

*Primary Phone:

This is a…

CellHomeWork

Secondary phone:

This is a…

CellHomeWork

Email address:

Additional person to add to your account, if applicable:

Last Name:

First Name

Cell phone:

We love social media! We may wish to to share your pet’s image and story on social media, our website, and other forms of related media and educational materials. Your full name and personal information will never be shared. Choose one:

Yes, I authorize Inman Park Animal Hospital to share my pets photo and story at any time.No, I do not consent to have my pets image and/or story shared.

TREATMENT CONSENT: By completing this form, you authorize the veterinarian(s) to examine, diagnose, and treat the below-described pet(s) to the best of their abilities. All in-patients must be current on vaccines and free from parasites. To comply with this policy, certain treatments may be necessary to protect the health and safety of all pets in our care. You assume responsibility for all charges incurred in the care of your pet(s).

FINANCIAL POLICY: We accept Visa, Mastercard, Discover and American Express, cash and checks. Full payment is due at the time of service. Clients with payment concerns are asked to speak to a staff member before the exam. We are happy to provide you with a written treatment plan prior to services being rendered. No payment plans are offered.

Your signature below indicates your agreement with hospital policies and all other information listed above.

*Signature:

*Date:

Treatment Admission

Do you have a particular time you would like to pick up your pet?

* ALL PETS ARE DISCHARGED DURING NORMAL CLINIC HOURS; FOR BATHS PLEASE PICK UP AFTER 4PM

Is someone else picking up your pet?

* All boarding pets MUST be current on vaccines and free of parasites (fleas, ticks, etc.), or they will be treated upon entry at owner's expense

Treatment: : (please check all that apply)

Canine Vaccines:

RabiesDHLPPBordetella

Feline Vaccines:

RabiesFVRCPFELV

Check stool for worms:

Test: heartworm (dogs):

Test: FELV & FIV (cats):

Bath:

YesWith Flea Control

Others (please describe)

I, the undersigned owner or authorized agent of admitted patient, authorize Kevin Fowler, D.V.M., and his designated associates and/or assistants, and/or staff, to administer such treatments and to perform such procedures considered therapeutically and/or diagnostically necessary for the care of said animal(s), including the administration of anesthesia. I understand that no guarantee of successful treatment is made. I accept financial responsibility for the treatment of the patient(s) named, and I understand that payment in full is due upon the release of said patient(s) from the hospital or when service is terminated. I hereby certify that I have read and fully understand this authorization for medical and/or surgical treatment, the reason why such medical and/or surgical treatment is necessary, as well as its advantages and possible complications, if any. I hereby release Dr. Fowler and his associates/assistants and/or staff from any and all claims arising out of or connected with the performance of his treatment

Your signature below indicates your agreement with hospital policies and all other information listed above.

Authorized granted:

SedationX-RaysChems/CBC/UA