Recheck Admitting Form

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Please complete the Recheck Admitting Form online before your appointment. This form helps our team gather important updates on your pet’s condition that needs to be rechecked so we can provide the best possible care.

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Recheck Admitting Form

Client Name *

Pet Name *

Date of Appointment *

Email *

What condition is being rechecked today? *

How long have you been treating this problem? *

Have you had any issues providing the recommended home care? (medicating, low activity, isolation, etc)?

Has your pet’s condition improved?

If your pet is experiencing any symptoms, please provide more details here: (how long, how often, how bad, etc)

Is your pet currently taking any medication? Please list the medication, dose and time last given.

Please do not write "On File". We need to verify that the medications you are actually giving your pet matches what we have on file.

Is there anything else you feel we need to be aware of?

For Inpatient Appointments:

If we find fleas on your pet during their hospitalization, we will administer CapStar flea treatment. You are responsible for the cost of treatment.

In order to treat your pet in a timely manner, it is extremely important that we are able to reach you by phone throughout the day. Please leave a number that will be answered and checked.

Primary Phone Number *

Alternate Phone Number

Do you want to receive text communications? *

I agree *

I agree to pay all charges for services provided by Martinez Animal Hospital upon discharge of my pet. Payments can be made by most major credit cards, CareCredit or cash. A credit card processing fee of up to 3% will be applied to all transactions made using credit/debit cards.

I understand *

I understand and accept the clinic's cancellation policy, which requires a minimum of 24 hours' notice for cancellations; otherwise, a cancellation fee may apply.

you you Number

I acknowledge *

I acknowledge the clinic's late policy, which states that while efforts will be made to accommodate appointments, if I am more than 10 minutes late, Martinez Animal Hospital may not be able to provide services, and a $10 late fee may apply.

Signature *

Clear Signature

Date *

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Recheck Admitting Form

Recheck Admitting Form

For Inpatient Appointments:

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