HOSPITAL CARE RELEASE FORM
I ____________________________ am admitting my pet _______________________
(Owner or responsible party)
(Pet’s name)
a ______________________________, for hospital care at My Pet’s Vet, from
(Color / breed)
_____________________________ to ___________________________ after 11:00 a.m.
(Date of admission)
(Date of release)
I realize that in case of medical emergency, Bridget Brooke, VMD at My Pet’s Vet will assist and treat my
pet as she feels medically sound and will make all reasonable attempts to contact me or a responsible party in the
event such a medical emergency should occur.
I realize that since my pet will be spending part of his/her stay at My Pet’s Vet in a caged environment, the
necessity for a bath prior to discharge may exist.
Would you like your pet bathed prior to discharge.______ YES______NO
Would you like your pet micro-chipped prior to discharge.______YES______NO
If you would like to contact the hospital to inquire as to your pet’s condition, please feel free to call during office
hours. Leave your contact information on our patient update mailbox and a staff member will return your call with
an update. We encourage your communication. Please call the day of discharge prior to coming over to the
hospital so that we may have your pet properly cleaned and ready for your arrival.
Your pet’s vaccinations are due ____________________. If vaccinations are required, they must be given prior to
admission to the hospital as we are concerned about the welfare of your pet and those around him/her.
Last time medications were administered: ___________________________________
List medications and instructions: ____________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
SPECIAL REQUESTS: _______________________________________________________
____________________________________________________________________________
__________________________________________________________________________________________
 Was your pet fed today? ___Yes ___No
 If yes, was it in the am or pm? ________
 Feeding schedule: ____AM ___PM ____Both
 Did you bring your own food? ___Yes ___No
PLEASE PROVIDE EMERGENCY CONTACT AND PHONE NUMBER SHOULD A MEDICAL
EMERGENCY ARISE: ____________________________________________________________________
_______________________________________
(Name of responsible party)
_____________________________________
(Telephone)
Signature________________________________
Date: _______________________