New Client Form

    Contact Information


















    How did you hear about us?


    Patient Infomation


    Pet Type


    Sex

    Spayed/Neutered





    Is your pet on any prescription or over-the-counter medications, or any supplements?


    Please note that all professional fees are due at the time the services are rendered. For your convenience, we accept cash, debit, personal checks, MasterCard, Visa, American Express and Discover.

    Symptom Checklist for Senior Dogs

      Symptom Checklist

      Instructions

      Please check all that apply to your dog:

      Behavior / Neurologic

      Body Functions

      Heart / Lungs

      Activity / Orthopedics


      Skin and Coat


      Prescriptions / Over-the-Counter / Supplements







      Symptom Checklist for Senior Cats

        Symptom Checklist

        Instructions

        Please check all that apply to your cat:

        Behavior / Neurologic

        Body Functions

        Heart / Lungs

        Activity/Orthopedics


        Skin and Coat


        Prescriptions / Supplements


        Contact Page Contact Form

          Consent Form

            Consent Form

            Sex

            I am the owner of the animal identified above and have the authority to execute this consent. I hereby consent and authorize the performance of the following procedure(s) or operation(s)

            Instructions I understand that during the performance of the previously indicated procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the procedure(s) or operation(s) or different procedure(s) or operation(s) then those set forth above. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as are necessary and desirable in the exercise of the veterinarian’s professional judgment. I also authorize anesthetics and other medications, and understand that hospital support personnel will be employed as deemed necessary by the veterinarian. I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I realize that results cannot be guaranteed.

            Pre-Anesthetic Blood Work

            Pre-anesthetic blood work is recommended by the doctors in order to evaluate the internal health of your pet before his or her anesthetic procedure.

            Pain Medication

            Pain medication will be administered to all surgical patients while in the hospital. If needed, additional pain medication will be sent home at the discretion of the doctor.

            I HAVE READ AND UNDERSTAND THIS AUTHORIZATION AND CONSENT.

            Would you like your pet to get a microchip?


            Boarding Admission Form

              Admission Form

              Sex

              * THERE IS A CHARGE FOR MEDICATIONS TO BE GIVEN WHILE YOUR ANIMAL IS BOARDING

              NOTE: All animals entering the hospital MUST be up to date on vaccinations and free of external parasites. (fleas, ticks, etc.), or they will be treated upon entry at the owner’s expense.

              Instructions

              Boarding can be stressful for some pets. Stress-related colitis can result from a change in environment, food, water as well as from noise from other pets. Should this occur, Montgomery Animal Hospital will conduct a stool sample analysis and prescribe a medication and/or special food while boarding.

              If tranquilizer is necessary for treatment or handling, I give my permission for Montgomery Animal Hospital to administer such medication. I understand that I will be responsible for the charge.

              Any pet requiring a bath, due to soiling prior to pick up will be bathed at the owner's expense.

              I also authorize Montgomery Animal Hospital to do whatever is necessary should an emergency situation arise. Payment is required when animal(s) is/are released.