(925) 228-7100 |  5055 Alhambra Ave, Martinez, CA 94553

Martinez Animal Hospital

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Patient Admitting/History Recheck Form

Your Name*
Has your pet's condition improved?*
Is your pet taking any medications?*
If your pet is taking medications, were they given today?*
Has your pet been eating normally?*
Has your pet been drinking normally?*
Are there other pets at home?*
Please list how many and what type (cat, dog, etc..)*
Species
Quantity
 
Do you authorize treatment as deemed necessary by the doctor?*
Any expenditures over that amount require my approval.
Late appointment policy*
By checking this box, you understand that if you are 10+ minutes late to your appointment, you are subject to a late appointment fee IF we can still see your patient. If we cannot see you because of your late arrival, you will be charged a missed appointment fee.
No show fee*
By checking this box, you understand that if you do not give us 24 hour notice of cancellation or the need to reschedule, you will be charged a missed appointment fee. Please note, you may be asked to pre-pay for you next appointment in addition to paying the missed appointment fee.
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Martinez Animal Hospital

Phone: (925) 228-7100 Address: 5055 Alhambra Ave, Martinez, CA 94553

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