Online Forms

Embassy Lakes Animal Hospital offers patient forms online so you can complete them in the convenience of your own home or office.

New Patient Registration Form - Required

This lets us record pets and owners into our management software so we can effectively and efficiently provide the service you deserve!

New Client Form

Welcome to Our Clinic Form

Payment Policy: full payment is required at the time of your visit. We accept cash, VISA, Mastercard, Discover, American Express, personal checks with Driver's License, and CareCredit.

Name *

Name

First

Last

Spouse's Name

First

Last

Email *

Home Phone *

Alternate Phone *

Address *

Address

City

State/Province

Zip/Postal

Employer *

Emergency Phone Number *

How Did You Hear About Our Practice *

If you are human, leave this field blank.

Dental Consent Forms

If your pet is having dental procedures and additional diagnostic testing performed, you will need to fill out the forms below and bring them with you to your appointment!

Dental Consent Form

I hereby authorize and direct Embassy Lakes Animal Hospital to perform the dental procedure and additional diagnostic testing and/or treatment deemed advisable for my pet. *

I authorize

Pet's Name *

Pre-Anesthetic Bloodwork

Like you, our greatest concern is the well being of your pet. Before putting your pet under anesthesia we will perform a physical examination. However, many conditions including disorders of the liver, kidneys or blood are not detected unless blood testing is performed. Such tests are especially important before any kind of anesthesia. The total cost of these important tests is $154.00.

Blood Testing *

I accept blood testing

I decline blood testing

Dentals

I understand that during a dental cleaning my animal’s teeth and gums will be evaluated. Dental extractions may be indicated due to exposed gums, infection, cracks, fractures, etc.

Extractions *

I authorize extractions

I decline extractions

Any estimates for the planned procedures are only approximations and the final bill may be greater or less than these amounts. I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal listed above and do hereby give Embassy Lakes Animal Hospital and it’s staff complete authority to perform the dental cleaning and/or extractions on my pet. I understand and agree to the above listed terms and acknowledge that fluids or additional medical therapy may be needed and accept all financial responsibility.

ALL SERVICES MUST BE PAID IN FULL WHEN MY PET IS RELEASED.

I do understand by declining extractions that there may be health risks as well as additional expenses associated with untreated dental disease. *

I understand

Would You Like Your Pet Microchipped Today? The cost for this service is $70.00.

Yes

DISCLAIMER: By signing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this document.

Signature *

Clear

Date *

Contact Telephone Number *

Email *

Captcha

If you are human, leave this field blank.

Surgical/Dental Consent Form

I hereby authorize Embassy Lakes Animal Hospital to perform the procedure and additional diagnostic testing and/or treatment as deemed advisable for my pet. *

I authorize

Pet's Name *

Would You Like Your Pet Microchipped Today? The cost for this service is $70.00.

Yes

Pre-Anesthetic Bloodwork

Like you, our greatest concern is the well being of your pet. Before putting your pet under Anesthesia, we will perform a physical examination. However, many conditions, including disorders of the Liver, Kidneys, or blood are not detected unless blood testing is performed. Such tests are especially important before any kind of Anesthesia. The total cost of these important tests is $154.00.

Blood Testing *

I accept blood testing

I decline blood testing

Dentals

I understand that during a Dental Cleaning, my pet’s teeth and gums will be evaluated. Dental Extractions may be indicated due to exposed gums, infection, cracks, fractures, etc.

Extractions *

I authorize extractions

I decline extractions

Growth Removals

I understand that during a surgical procedure, there are always risks involved. The nature of the procedure has been explained to me and no guarantee has been made as to the result or cure. To determine proper follow-up treatment, the veterinarian may suggest sending a sample to the lab to diagnose the type of growth being removed. The cost of histopathology is $120.00

Histopathology *

I authorize histopathology

I decline histopathology

Any estimates/charges for the planned procedures are only approximations and the final bill may be great or less than these amounts. I, the undersigned do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above and do hereby give Embassy Lakes Animal Hospital and it’s staff complete authority to perform the dental cleaning and/or extractions and the surgical procedure on my pet. I understand and agree to the above listed terms and acknowledge that fluids or additional medical therapy may be needed and I accept all financial responsibility. All services must be paid in full when my pet is released.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this document.

Signature *

Clear

Date *

Best Number To Contact You *

Email *

Captcha

If you are human, leave this field blank.

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues, news, and events in our office. You can print it out and bring it in any time. The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Member Wellness Registration Form

Member Wellness Registration

Website Member Wellness Registration

To become a registered member with our office simply fill out the form below. Once your membership request has been approved, you will be notified via email. Please make sure the email address you provide is accurate. Please note that we respect your privacy, and will not loan, sell, or otherwise distribute your personal information to any third party. Fields marked with an * are required for registration.

Name *

Name

First

Last

Address *

Address

City

State/Province

Zip/Postal

Phone *

Fax

Birthday *

Member Log-In:

Specify desired email address and password for website access

Email *

Password *

Would You Like To Receive Special Announcements From The Office And A Free Subscription To The Newsletter?

Yes

Check Off Topics of Interest *

Dogs

Cats

Birds

Reptiles

Horses

Rodents

Doctor's Announcements

Captcha

If you are human, leave this field blank.

Surgical Consent Form

You will need to print and sign this form when you bring in your pet for surgery!

Surgical Form

Surgical Consent Form

I hereby authorize Embassy Lakes Animal Hospital to perform the procedure and additional diagnostic testing and/or treatment as deemed advisable for my pet. *

I authorize

Pet's Name *

Pre-Anesthetic Bloodwork

Blood Testing *

I accept blood testing

I decline blood testing

I understand that during a surgical procedure, there are always risks involved. The nature of the procedure has been explained to me and no guarantee has been made as to the result or cure.

ALL SERVICES MUST BE PAID IN FULL WHEN MY PET IS RELEASED.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this document.

Signature *

Clear

Date *

Best Number To Contact You *

Email *

Captcha

If you are human, leave this field blank.

Growth Removal Form

Growth Removal Consent Form

I hereby authorize and direct Embassy Lakes Animal Hospital to perform the surgical procedures and additional diagnostic testing and/or treatment as deemed advisable for my pet. *

I authorize

Pet's Name *

Pre-Anesthetic Bloodwork

Like you, our greatest concern is the well being of your pet. Before putting your pet under anesthesia we will perform a physical exam. However, many conditions including disorders of the liver, kidneys or blood are not detected unless blood testing is performed. Such tests are especially important before any kind of anesthesia. The total cost of these important tests is $154.00.

Blood Testing *

I accept blood testing

I decline blood testing

Growth Removals

I understand that during a surgical procedure, there are always risks involved. The nature of the procedure has been explained to me and no guarantee has been made as to the result or cure. To determine proper follow up treatment, the veterinarian may suggest sending a sample to the lab to diagnose the type of growth being removed. The cost of histopathology is $120.00

Histopathology *

I authorize histopathology

I decline histopathology

Would You Like Your Pet Microchipped Today? The cost for this service is $70.00. *

Yes

Any estimates or charges for the planned surgical procedures are only approximations and the final bill may be greater or less than these amounts. I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal listed above and do hereby give Embassy Lakes Animal Hospital and it’s staff complete authority to perform the surgery and/or growth removal on my pet. I understand and agree to the above listed terms and acknowledge that fluids or additional medical therapy may be needed and accept all financial responsibility.

ALL SERVICES MUST BE PAID IN FULL WHEN MY PET IS RELEASED.

DISCLAIMER: By signing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this document.

Signature *

Clear

Date *

Contact Telephone Number *

Email *

Captcha

If you are human, leave this field blank.