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Hospital Intake Form

Please complete this form and submit prior to your arrival at the Hospital for your pet's procedure(s). If you have any questions please call us or email [email protected].

Need a Prescription Refill?

Weste Animal Hospital is now handling all of our prescription refills through the PetDesk app, where you can track your pet’s wellness, request appointments, and refill prescriptions all in one place.

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Owner & patient details

MM slash DD slash YYYY

Health condition history

Owner's consent

I authorize the performance of the identified procedure(s) listed above and the use of associated anesthetics and other medications deemed necessary. I also understand that unforeseen conditions may be revealed during the identified procedures which, if in the opinion of the attending veterinarian require more extensive or different procedures or treatments, I authorize the vet use their judgment as needed. I understand that reasonable efforts will be made to contact me to explain these procedures and treatments and obtain my instructions regarding them. However, if the efforts are unsuccessful, I authorize the performance of any procedures and treatments which are necessary in the professional opinion of the attending veterinarian. Additional charges may apply. We will make every effort to keep within the estimate but sometimes procedures take longer than expected or differ from the estimate and the price may vary.*
I agree to pay the total balance as per the estimate given, for the above procedures and related clinic fees. I will pay the balance at the time the pet is discharged and hereby acknowledge my indebtedness for this amount.*
Consent*