Pet Name *

Owner Name *

First

Last

Phone Number (where you can be reached today) *

I consent to receive SMS text messages from San Antonio Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Available time of pickup:

Text
Phone Call

Reason for drop off: Please describe the problem. Include color, size, amount, times per day, etc. Explain details for the doctor.

In some cases it is necessary to use sedation in order to safely evaluate your pet’s condition. Does the doctor have permission to sedate your pet? *

Yes
No

(Sedation $125.00)

**Does your pet have a history or seizures? *

Yes
No

Has your pet had anything to eat or drink today? *

Yes
No

Allergies *

Current Medications:

Does the doctor have permission to perform basic diagnostic tests related to the health problem of your pet? *

Yes
No

Vomiting/Diarrhea:

CBC/Chemistry/Electrolytes/Urinalysis $219.00
Fecal Exam (Float & Smear) $70.00

Coughing:

Chest Radiographs with Radiologist Review $349.00

Urinary Tract Infection:

Urinalysis $69.00

Ear Infection:

Ear Cytology $37.00

All animals entering the hospital must be current on vaccinations and on flea / tick preventative. Those who do not meet these requirements will be treated at the owner’s expense.

I understand and agree that I am at least 18 years of age, I am authorized to approve services to be performed and I am responsible for the balance of my account, to be paid at the time services are rendered. In addition to services I may request, I specifically authorize you to perform any services reasonably necessary to provide and protect the health and well being of my pet, other pets at the hospital and hospital staff.

I understand that results of the treatment can not be guaranteed and that there are certain risks involved in any treatment or procedure. I understand that San Antonio Animal Hospital and the staff will perform their duties to the best of their abilities to insure the health of the pet. I hereby release San Antonio Animal Hospital, their agents, staff and or representatives from any liability arising from treatment of the pet described above.

Signature *

Clear Signature

Date *

Consent of Treatment Form

Consent of Treatment Form

Book An Appointment

Online Pharmacy

Join Our Team

Address

Contact

Hours

We proudly serve the pets of San Antonio, FL and the Surrounding Areas:

Contact us