Consent Form for Day-time Admissions

Thank you for dropping off your pet with us today. This questionnaire helps to gather health information on your pet. Please be detailed and specific as much as you can.

Today's Date
Date Format: DD slash MM slash YYYY
Name
First Last
Preferred Phone #
Alternative Phone #
Who do we contact to get permission to make medical or financial decisions?
Pet's Name
Breed
Chip Number
Sex
Colour
Reason for Visit (check all that apply)
- Annual Wellness Exam
- Six Months Wellness Exam
- Vaccinations
- Heartworm Screen
- Blood Sampling
- Faecal Analysis
- Tick Fever Screen
- Illness
Please specify if you selected 'Illness'
Are there any concerns for: (check all that apply)
- Eating
- Drinking
- Bad Breath
- Weight Loss
- Itching / Scratching
- Difficulty Standing
- Scooting
- Shaking Head
- Lamenen
- Vomiting
- Diarrhoea
- Skin Masses / Lesions
- Urination Issues
When did your pet last eat?
Has your pet ever had an adverse reaction to any medications?
- Yes
- No
If yes, please describe
Has your pet ever had an adverse reaction to any vaccines, sedation, or any procedure?
- Yes
- No
If yes, please describe
Is your pet taking any medication(s)
- Yes
- No
If yes, please list medication(s)
Do you need a refill of these medication(s)
- Yes
- No
If yes, please list medication(s) in need of refill
Additional Services (Please indicate if you would like your pet to receive any of the following services)
- Pedicure
- Anal Gland Expression
- Heartworm Preventative
- Microchipping
Please call me if treatment fee will be over:
*if left blank, we will call if the fee is over $100
Consent*
I give consent for day-time addmision.

Visit Us

Harbour Bay Shopping Plaza
East Bay Street,
Nassau, Bahamas

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Contact

Telephone: 242 698 7387
Fax: 242 698 7389
Email: hello@amgvetsnassau.com

EMERGENCY 24/7: 242 807 7960

Our Hours

Monday-Friday: 8:30 am – 5 pm
Saturday: 9:00 am – 2 pm
Sundays/ Public Holidays: closed