Nursing appointment admitting formNursing appointment admitting form Admitting form for nurse appointments Client Name(Required) First Last Pet Name:(Required)Species(Required) Dog CatWhat is this appointment for?(Required)VaccinesLabworkNail TrimOtherIf other, please explain. Enter "n/a" if not applicable.(Required)Is this a recheck appointment?(Required) Yes NoIf yes (recheck appointment), is your pet responding to treatment? Please explain.(Required)Is your pet currently taking any medications?(Required) Yes NoIf yes, please list the medications and the dosing instructions you follow. (Please list out so we can verify this with our records.) If none, say "n/a"(Required)Is your pet eating and drinking normally?(Required) Yes NoIf no, please explainIs your pet urinating and defecating normally?(Required) Yes NoIf no, please explainIs there any:(Required) Coughing Sneezing Vomitting Diarrhea N/aSelect AllAre there any services you are requesting that were not relayed at the time of scheduling? If none, say "n/a" (See service agreement below)(Required)Do you need any written prescriptions or any medication filled at the time of the appointment (this includes prescription food or flea/tick prevention)?(Required)Service acknowledgement(Required) I agree to the Service acknowledgement.If you are requesting services that were not already relayed at the time of scheduling, including a Doctor examining your pet or "taking a peek" at something, the availability to provide the additional services is up to our discretion and there will be a charge for these services.Contact number(Required)Can we text you while your pet is here?(Required) Yes NoLate appointment policy(Required) I agree to the Late appointment policy.If you are 10+ minutes late to your scheduled appointment, we will most likely reschedule your appointment. In the chance we have to reschedule, you will be charged a missed appointment fee.No show/late cancellation policy(Required) I agree to the no show/late cancellation policy.If you do not provide us 24 hour notice of cancellation or rescheduling, you will be charged a missed appointment fee. By agreeing to this policy, you understand that you may be asked to pre-pay for your next appointment in the chance you do not give us 24 hour cancellation notice.Signature(Required)
