Day Admission Form

Save time during your pet’s boarding appointment. Complete your day admission form online before your visit.

Day Admission Form

Please complete this form as completely and accurately as possible so we can get to know you and your pets before your visit.

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Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Contact Phone Number *

Other

Emergency Contact Name

Phone Number

PET INFORMATION

Pet’s Name

Breed

Color(s)

Age/Birth Date *

Species *

Dog
Cat
Other

Sex *

Male
Female

If your pet is found to be carrying any parasites, including fleas, they will be treated to prevent the spread to other patients in the clinic, and you will be responsible for the additional cost. An exam will be performed by the veterinarian and you will be contacted to discuss an estimate/treatment plan

What is the reason for your pet to be seen today?

If your pet is visiting us due to illness or injury, how long have they been sick/injured? *

How has your pet’s appetite been?

Normal
Decreased
Increased
Not eating for

My pet’s normal diet is

Has your pet had any people food, new treats, gotten in the trash, or eaten anything they shouldn’t have in the past 7 days?

Yes
No List

My pet’s bowel movements are

Normal
Diarrhea
Constipated for
Have blood present

My pet has been vomiting

Yes
No for

Describe

Is your pet currently taking any medications daily or on monthly preventatives?

Do you have proof of up-to-date vaccinations for your pet?

All patients 12 weeks and older must have an up-to-date rabies vaccine given within the past 12 months. Documentation from a licensed veterinarian is required prior to or at the time of admission. Patients who are not up-to-date will receive a rabies vaccine today as long as the veterinarian deems it safe.

Do you authorize blood work to be performed on your pet?

Do you authorize diagnostic imaging to be performed on your pet?

I would like my pet to be bathed while it is here ($20-45)

In the event your pet’s condition becomes critical during their stay, please check one of the following options:

I authorize Vidalia Veterinary Clinic to perform emergency and/or lifesaving treatments and diagnostics on my pet. I agree that I will be responsible for any incurred expenses regardless of the outcome.
I do NOT authorize Vidalia Veterinary Clinic to perform emergency and/or lifesaving treatments and diagnostics on my pet. I understand and accept that my pet may die if no intervention is taken.

I understand that if I cannot be reached at the phone numbers provided to discuss recommended treatments outside of the already authorized services/estimate, nothing else beyond a physical exam and those services requested will be done on my pet today. Any pets dropped off will not be ready for discharge until 5:00 pm unless told otherwise.

Date *

Day Admission Form

Day Admission Form

PET INFORMATION

We’re excited to meet you!

Contact

Address

Hours

After Hours Emergency

Questions?