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Wylie Veterinarians Near Murphy, Lucas, and Lavon | Lake Lavon Animal Hospital

Contact Us

456 N. Country Club Rd #110 Wylie, TX 75098 Call or Text us at 972-429-7901 info@lakelavonanimalhospital.com lakelavonvet@gmail.com

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   Medical Day Admission Form
 Home » Forms » Medical Day Admission Form


Medical Day Admission Form
Please complete this form for patients being admitted for medical care.

We must receive this Medical History form 24 hours prior to your pet's appointment or the appointment will be released to another pet in need of care.*

I have read and understand.
Today's Date*
Client Name*
Contact Number*
Please enter the best phone number to reach you today.
Patient Name*
Have we seen your pet before?

Yes


No
Briefly describe your concern about your pet.*
Please list all medications your pet takes.*
Did your pet eat today?*

Yes


No
If yes, at what time?
Has your pet experienced a change in appetite?*

No


Yes, not eating at all


Yes, decreased appetite


Yes, eating treats only


Yes, eating more than usual
Check all that apply
Have you observed a change in water consumption??*

No


Drinking more


Drinking less


Not drinking at all
Check all that apply
Has your pet experienced any Vomiting?*

No


Yellow


Pink or red


Phlegm or mucus


Food
Check all that apply
If vomiting, when did your pet last vomit?
Does your pet have a history of eating:*

Garbage


Toys


String


Socks/Towels/Blankets


None
Check all that apply
Has your pet experienced any diarrhea?*

No


Watery


Bloody


Mucus


Tarry
Check all that apply
What time did your pet last have diarrhea?
Have you observed any change in urination?*

No


Blood in urine


Increased frequency


Increased amount


Accidents at home


Urinating outside litter box


Straining


Vocalizing


Excessive licking vulva or penis
Check all that apply
Have you observed any Coughing or Sneezing?*

No


Moist


Dry


Honking


Seasonal


Occurs at night


Occurs during the day


Occurs after physical activity
Check all that apply
Has your pet been exposed to other animals within the last 7 days? (Groomer, Day Care, Boarding, or at a home with other people's pets)*

No


Yes
Have you observed any Lumps, Bumps, or Rashes?*

No


Bloody discharge


Clear discharge


Thick discharge


Hair loss


Irritation or excessive scratching
Check all that apply
Please describe where they are located on your pet
Is your pet Limping or become Lame?*

No


Seems painful


Toe touching


Completely non-weight bearing
Check all that apply
Which limb are they limping on or favoring?
Please tell us any additional information, including when you first noticed symptoms.*
I understand my pet will receive a medical exam today ($70).*

Check this box to acknowledge
I understand diagnostic tests may be necessary to detect problems that are not evident with the physical exam alone.*

Check this box to acknowledge
If deemed medically necessary, I authorize the following diagnostics:*

Select All


Diagnostic blood work


Urinalysis


Radiographs (xrays)


Do whatever is needed


I do not authorize additional treatment of any kind without my consent
In the event of an emergency, or if further diagnostics are needed, we will make our best effort to reach you at the number provided above. However, should we be unable to reach you, please indicate how you wish for us to proceed.
I authorize additional treatment up to $_____*
Please enter dollar amount
May we sedate/anesthetize your pet if necessary?*

Yes


No
Sedation may be needed to relieve pain, fear or anxiety in sick or injured patients.
Client Signature:*

 












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Contact Us

456 North Country Club Rd

Wylie, TX

75098

972-429-7901
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Location Hours
Monday	7:30am – 5:30pm
Tuesday	7:30am – 5:30pm
Wednesday	7:30am – 5:30pm
Thursday	7:30am – 6:30pm
Friday	7:30am – 5:30pm
Saturday	Closed
Sunday	Closed *closed Saturdays as of Jan. 1, 2023

Pet Health Resources

Location Hours Monday 7:30am – 5:30pm Tuesday 7:30am – 5:30pm Wednesday 7:30am – 5:30pm Thursday 7:30am – 6:30pm Friday 7:30am – 5:30pm Saturday Closed Sunday Closed

*closed Saturdays as of Jan. 1, 2023

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