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Hospitalization Form

Client Name(Required)

First

Last

Date

Phone(Required)

Pet Name

Hospitalization Services

Consent

I authorize the veterinarians of East Paulding Animal Hospital and their staff to examine the above said patient, if needed, and contact me as to what the problem is, and the cost of treatment.

Consent

I authorize East Paulding Animal Hospital to perform medical procedures if needed.

Consent

I further agree to pay in full at the time of discharge unless prior arrangements have been made.

FOR THE SAFTEY OF YOUR PETS, PLEASE REMOVE ALL COLLARS. WE ARE NOT RESPONSIBLE FOR LOST
COLLARS, TOYS OR BLANKETS.

I understand that the attending veterinarian will make every effort to contact me regarding treatment in the case of unforeseen emergencies. If unable to contact me, the staff may or may not have my permission to proceed with life-sustaining procedure.

Do you give permission?(Required)

Yes, I give my permission

No, I do not give my permission

Owner/Authorized Representative(Required)

Emergency Phone Number(Required)

CAPTCHA

Hospitalization Form

FOR THE SAFTEY OF YOUR PETS, PLEASE REMOVE ALL COLLARS. WE ARE NOT RESPONSIBLE FOR LOST
COLLARS, TOYS OR BLANKETS.

Get in touch

770-445-7300

Business Hours

770-445-7300

Hospitalization Form

FOR THE SAFTEY OF YOUR PETS, PLEASE REMOVE ALL COLLARS. WE ARE NOT RESPONSIBLE FOR LOST COLLARS, TOYS OR BLANKETS.

Get in touch

770-445-7300

Business Hours

770-445-7300

FOR THE SAFTEY OF YOUR PETS, PLEASE REMOVE ALL COLLARS. WE ARE NOT RESPONSIBLE FOR LOST
COLLARS, TOYS OR BLANKETS.