Admit Appointment Consent Form

Save time at your first appointment by completing your admit appointment consent form online or by printing a copy to turn in at your visit.

Admit Appointment Consent Form

Welcome to Potlatch Veterinary Clinic! To ensure the best care for your pet during their visit, please complete our admit appointment consent form. This form allows us to gather essential information about your pet’s needs and treatment preferences, ensuring a smooth and efficient appointment.

You may use the PDF version by clicking the DOWNLOAD FORM button and then completing the printed form by hand. Please bring the completed PDF form with you for your appointment.

Client Details

Patient Details

Please verify the information above

After Examination: Please select one option below

Diagnostics Approval and Cost Estimate

History

If yes, please provide the following details

You can check all that apply, or leave blank if none are applicable.
To confirm that you reviewed and agrees to the statements.
To acknowledge understanding of flea treatment if fleas are found on the pet.
To acknowledge that you understands they will not hold the clinic responsible for any complications.
To confirm that the client is the owner and authorized to sign the release.
Clear Signature