Skycrest New Patient Form

How did you become aware of our hospital?
Friend or Co-Worker
Internet Search Engine
Yellow Pages
Hospital Sign

TELL US ABOUT YOUR PET (Please Submit A New Form For EACH Pet)

Your Dog's Vaccination History
Your Cat's Vaccination History
Is your pet allergic to any medication or vaccination?
Is your pet on any
special food or medication?

We will gladly prepare a written estimate if you desire (please ask our doctors or receptionist).  This will be important to you since ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.
In cases of extensive medical or surgical prodedures, when full payment may be difficult at discharge,
we accept all major credit cards, or we can establish a payment arrangement
if approved in advance of the treatment.
There will be a $25.00 service charge for any check returned unpaid.

To prevent the spread of infectious diseases, all hospitalized and boarded patients must be current on all vaccines and free from internal and external parasites.  By clicking on the SUBMIT button below, you authorize this level of preventive care and you agree to pay the appropriate charges
assessed in the discharge invoice.

By submitting this online form, I agree to be responsible
for authorizing procedures and/or paying for services.

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