Patient Admitting/History Recheck Form What condition is being rechecked today?*How long have you been treating this problem?*Are there any other concerns?*Has your pet's condition improved?* Yes No How do you feel the treatment(s) have been going? Any difficulties?*Has your pet been eating normally?* Yes No Has your pet been drinking normally?* Yes No Are there other pets at home?* Yes No Please list how many and what type (cat, dog, etc..)*SpeciesQuantity Do you authorize treatment as deemeed necessary by the doctor?* Yes No Contact first I authorize Martinez Animal Hospital to charge up to*Any expenditures over that amount require my approval.In order to treat your pet in a timely manner, it is extremely important that we are able to reach you by phone throughout the day. Please leave a number that will be answered and checked, Our first concern is for your pet.*Name* First Last Signature*
