Client Forms in Columbus, OH

Fill out and submit any of the necessary online forms provided below in preparation for your pet’s upcoming appointment.

If you have any questions, please contact us at (614) 476-0000.

Surgery and Anesthesia Form

Easton Animal Hospital staff ask that you please wear a mask when we interact with you at your car as we are helping bring in and return your pet to you. It is so important that we stay healthy so we can continue to help you and your pet.

Name *

Name

First

Last

Address *

Address

City

State/Province

Zip/Postal

Phone *

Email you would like us to have for your pets reminders *

Patient Name *

Species *

Breed *

Is your pet *

Female

Male

Unknown

Is your pet *

Spayed/Neutered

Intact

Unsure

Primary Color *

What surgical procedure is your pet scheduled for? *

Since your pet is getting a full physical today, are there any questions or concerns that you would like to doctor to address? *

At your surgery check-in, we will go over options of bloodwork, placing an IV catheter, and running fluids throughout the procedure.

To minimize some of the risks that are involved in surgery, please answer the following questions:

When did your pet eat last? *

Is your pet on monthly heartworm preventative? *

Yes

Please list all medication, dosage, frequency, and time last dose given *

I understand that some risks always exist with anesthesia and/ or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure(s) is/are initiated. Since no anesthetic or surgical procedure is trivial or routine, we assure you that your pet will receive a full physical examination prior to anesthesia, and that he/she will be monitored before, during and after the procedure. Regardless of age or health, anesthesia and surgery present a small but real risk to your pet. The doctors choose the safest anesthetic drugs, monitoring equipment and personal attention to minimize these risks as much as possible. *

I understand and agree

CPR Consent

Should my pet require CPR (Cardiopulmonary Resuscitation), including but not limited to cardiac compressions, positive respiration, emergency medications, or other heroic interventions, I consent that the doctors at Easton Animal Hospital are given my permission to conduct such medical care. I also understand the following:

I agree to be financially responsible for all veterinary services provided to my pet while Easton Animal Hospital team members pursue treatment.
I understand that regardless of my pet’s recovery or survival I agree to pay the CPR fee in addition to other fees already identified by the practice and agreed upon by me.
I understand that despite the best efforts of the doctors and team members, CPR may not be successful.

Please choose one of the following *

Microchip Implantation *

Yes, I want and authorize a microchip implantation

No, I do not authorize a microchip implantation

No, my pet already has a microchip

Microchip number

By signing my signature on the bottom of this page, I understand this to be my expressed and written consent for anesthesia and surgical procedures on my pet. *

Clear

Date *

COVID-19 Acknowledgement

For the protection of both our team and clients, have you been exposed to COVID-19 or showing signs/experiencing symptoms of COVID-19 in the last 14 days? *

Yes- we can still perform surgery on your pet, please give us a call

You may leave your pets leash, collar, and/or harness on and we will apply our slip leash as well when bringing your dog into the hospital. All cats and pocket pets must be in a carrier for the staff to bring your pet into the hospital *

I understand

Captcha

If you are human, leave this field blank.

New Client Form

Owner's Name *

Owner's Name

First

Last

Secondary Contact Name

First

Last

Address *

Address

City

State/Province

Zip/Postal

Primary Phone *

Secondary Phone

Email you would like us to use to send your pets reminders. *

Please enter the date of your scheduled appointment with us *

Please enter the time of your scheduled appointment with us *

How did you hear about us? * How did you hear about us?

Have You Been to Our Facility Before? *

Yes

Since we need to come to your car, please list the following information about your vehicle: Make, Model, Color *

What phone number should we use to contact you or the person who is bringing your pet (if not you)? *

Pet's Name *

Age/Birthday *

Breed *

Gender *

Male

Female

Spayed/Neutered *

Yes

Is your pet microchipped? *

Yes

If you have the microchip number available, please type it below

Please tell us the reason for your visit *

Do you have any other questions or concerns that you would like to have addressed at your visit? *

Has your pet been seen by any other veterinarian? *

Yes

Where were they seen?

Can you e-mail your pet's records to info@eastonanimalhospital.com? *

Yes

Are we able to contact the previous facility and get records? *

Yes

For the protection of both our team and clients, have you been exposed to COVID-19 or showing any symptoms/signs of COVID-19 in the last 14 days? *

Yes- We can still see your pet! We have the ability through teleconferencing to be able to see your pet safely. Please download the Zoom application through the Google Play Store or Apple Store and give us a call!

You may leave your pets leash, collar, and/or harness on and we will apply our slip leash as well when bringing your dog into the hospital. All cats and pockets pets must be in a carrier for the staff to bring your pet into the hospital.

I understand

I also understand the following:

I agree to be financially responsible for all veterinary services provided to my pet while Easton Animal Hospital team members pursue treatment.
I understand that regardless of my pet’s recovery or survival I agree to pay the CPR fee in addition to other fees already identified by the practice and agreed upon by me.
I understand that despite the best efforts of the doctors and team members, CPR may not be successful.

By typing my signature on the bottom of this page, I understand this to be my expressed written consent to accept or decline CPR services. *

Decline

Signature *

Clear

Captcha

If you are human, leave this field blank.

Client Forms in Columbus, OH

CPR Consent

COVID-19 Acknowledgement

2959 Stelzer Rd
Columbus, OH 43219

(614) 476-0000

(614) 476-1312

Client Forms in Columbus, OH

2959 Stelzer Rd Columbus, OH 43219

(614) 476-0000

(614) 476-1312

2959 Stelzer Rd
Columbus, OH 43219