Drop Off Admission Online Form

Home » Forms » Drop Off Admission Online Form

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

  • The information you provide below will let us know the best way to help your pet and how to exceed your expectations. It is important to be as accurate and as thorough as possible. Please leave 2 telephone number where you can be reached today:

  • Please leave 2 telephone number where you can be reached today:
  • Your pet will receive a physical exam today ($66). We will call you to discuss our findings and recommendations. We will go over any further estimated costs for services/diagnostics.
  • :
  • Date Format: MM slash DD slash YYYY
  • :
    If no, please see reception.

  • How is your pet feeling? Below are a few signs to indicate.

  • Some diagnostic tests help us in detecting problems that are not found on a physical examination. We will contact you following your pet's physical examination and provide an estimate for recommended testing.

  • I authorize Pet Hospital to perform the procedures as indicated above.I understand the doctor or technician will contact me after my pet has been examined to discuss recommended tests, which may include x-rays and bloodwork along with a recommended treatment plan. I understand that the doctor will not proceed with any tests, or treament until I have given verbal or signed authorization to the recommendations and estimate given to me. I authorize the hospital staff, in an emergency situation, to perform any additional procedures necessary for the well-being of my pet until further communication with me. I understand that payment is due in full at the time of discharge. I understand that follow-up examinations and additional treatments are not covered in today's total. I understand that no guarantee for successful results is made.

Map & Directions

Healthy Pet Hospital & Grooming
3411 E. Chapman Ave.
Orange, CA 92869
714-771-3261

Healthy Pet Hospital & Grooming  is conveniently Located in Orange just off the 55 Freeway at Chapman Avenue.

Forms Of Payment Available:

Click Here: