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Opening Hours: Monday - Friday 9am - 7pm Saturday & Sunday 9am - 5pm Phone Number: 518-893-6228 Email: info@greenfieldvets.com

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   Patient Check-in/Drop off admission form
 Home » Forms & Guides » Patient Check-in/Drop off admission form


Patient check-in/ Drop off form
Pre check-in form

Name*



First




Last


Appointment Date*

Date Format: MM slash DD slash YYYY

Pets Name*



First


Age*Please enter a number from 0 to 22.
Sex*
Contact Information
* If your pet is a drop here for a drop off appointment today we will need to be able to contact you or someone with permission to make medical and financial decisions regarding your pet.

Please list below who we will be in contact with during todays appointment.
Primary Contact Name*



First




Last


Phone Number*
Secondary Contact Name (if we are unable to reach you)*



First




Last


Phone Number*
Would you prefer a text when your pet(s) exam is completed?*

Yes


No


N/A
Appointment Information
Reason For visit: Select ALL that apply*

Vaccines/Wellness


Surgical Consult


Dental Evaluation


Comprehensive Exam


Behavioral Consult


Weight Mgt or Nutritional questions


Injury


Illness


Rehabilitation Consult
If injury, illness or other was selected please write a brief description:
Additional concerns: Select ALL that apply

Eating


Drinking


Bowl movements


Urinating


Weight loss


Vomiting


Diarrhea


Coughing


Sneezing


Weight Gain / Loss


Bad Breath


Drooling


Lethargy


Restless


Itching/Scratching


Smelly ears


Scooting


Behavioral Changes


Discharge


Other
Additional comments on reason for visit or concerns:
Did your pet eat this morning?*

Yes


No
If yes, at what time?
Medications / Supplements / Prevention:
Please complete the following questions to the best of your ability. 
Is your pet on any prescription medications at home?*

Yes


No
If yes, what? And when was the last dose?Medication: Last dose given:  
      
Supplements/Over the counter medications?*

Yes


No
If yes, what?Supplement:  
      
Does your pet have any allergies?*

Yes


No
If yes, to what?  
      
Is your pet on flea tick and heartworm prevention?*

Yes


No
If yes, what products?Flea/Tick  prevention Heartworm Prevention  
      
Refill Requests for today
Do you need any medication/supplements refilled for your pet today?*

Yes


No
If yes, what?Medication/ Supplement  
      
Do you need a refill of your pets flea/tick prevention?*

Yes


No
Do you need a refill of your pets heartworm prevention?*

Yes


No
Patient History
Please complete the following questions to the best of your ability. 
Has your pet ever had an adverse reaction to any medications?*

Yes


No
Has your pet ever had an adverse reaction to any medications?*

Yes


No
If so, explain:
Does your pet have any previous health concerns or diagnosis that we should know about?*

Yes


No
If so, explain:
Do you have any other pets?*

Yes


No
If so please list them below.       
Services
Are there any services that you would like done during your pet(s) visit?  
Please select all that apply.(NOTE: Additional costs will apply with services chosen.)


Nail trim


Fecal exam


Ear Cleaning


Microchip application


Anal glands


Brush out


Tooth brushing


Sanitary trim


Other
If "other" was selected please write the service you would like to have completed.
CONSENT
Information for visiting pets. Please read and check the provided box**A flea control product will be administered to pets with live fleas. This makes your pet more 

comfortable and protects our hospital and other patients from possible flea infestation.*  

When given, a charge will appear on your statement.
 By checking this box you understand give permission to treat.
CONSENT
Emergency /Urgent / or Surgical cases. Please read and initial. 
Preanesthetic Blood panel:* This is performed for every patient and is included in the estimate for every 

general anesthetic procedure. Some abnormal results may warrant additional testing, and your medical 

team will contact you to discuss additional evaluation. In some instances, the anesthetic procedure may 

be postponed or cancelled.
 By checking this box you understand and give permission to treat.
Critical Intervention:* Critical intervention may be needed to maintain normal heart rate, blood pressure and oxygen levels. In those situations, client permission for critical intervention may not be immediately obtained and additional charges may apply.  
 By checking this box you understand and give permission to treat.
Diagnostic testing:Diagnostic testing may help us detect any problems that are not found on the physical exams. Once the exam is completed by the doctor, our hospital will contact you prior to conducting any further testing. At the time of contact, if necessary, we will offer a treatment plan that will help us provide a diagnosis for your pet. 
 By checking this box you understand and give permission to treat.

 














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  Patient Check-in/Drop off admission form
Our Team
 Our veterinarians are dedicated to providing the best possible healthcare by getting to know you and your pet.

Meet Our Team

Are you a New Client?
 Here at Greenfield Animal Hospital, we always welcome new clients and patients to our full service veterinary practice in Saratoga County, New York.

New Client Resources

Vet Services We provide a wide variety of veterinary services to assist you and your pet. Learn more about the services we offer and how we're different.

Rehab & Fitness Center Greenfield Animal Hospital is proud to announce that our new small animal rehabilitation and fitness center is now open! This is a brand new state of the art facility houses numerous modalities.

Pet Salon & Spa Utilizing part of the upstairs building, Greenfield Animal Hospital added on a full time Salon & Spa Grooming services in the Fall of 2012, to further provide all in one experience for you and your pet!

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