Pet Illness Medical History

Please include name of medication, amount given and time given.
Please include name of medication, amount given and frequency given.
My pet is lethargic *

My pet has lost weight *

My pet has gained weight *

My pet is urinating more *

My pet is urinating innappropriately *

My pet is losing their hair *

My pet is coughing *

My pet is drinking more *

My pet seems constipated *

My pet has a lump *

My pet's skin is red, itchy, bumpy etc. *

My pet's urine is abnormal (color, consistency) *

My pet has difficulty breathing *

My pet is vomiting *

My pet is having diarrhea/abnormal stools *

My pet has an eye issue *

My pet is

This problem has

When did this happen?

Would you like us to *


Consent *

I am the owner/agent for the described animal; I authorize and request an exam for my pet.

I understand the veterinarians and/or staff at McPhillips Animal Hospital will contact me after my pet’s examination to discuss recommended diagnostics and treatment. If requested, all efforts will be made to reach me prior to the administration of any treatments prior to them being performed. If I cannot be reached, I authorize initial treatment, including fluid support and other supportive medications, to be started as indicated for my pet.

I understand that during the performance of the examination and potential procedures, unforeseen conditions may arise that necessitate additional or different procedure(s), operation(s), or treatment(s) than those set forth. Therefore, I hereby consent to and authorize the performance of such as are necessary and desirable in the exercise of the veterinarian’s professional judgment.

I understand and accept that when sedation and/or anesthesia are involved, there are always inherent risks including death.

The nature of the examination/diagnostics has been satisfactorily explained to me and no guarantee has been made as to the result or cure. I understand there may be risk involved in these procedures.

I understand that I will be charged for flea medication and a dose will be applied if evidence of fleas is found on my pet today.

I understand that payment is due when my pet is discharged; however, a deposit may be required after an estimate is prepared and discussed. I accept financial responsibility for charges incurred for this pet.




Security Question *