Home Services Doctors & Staff Pet Health Information BHPH News Contact







Mon 7:30 am - 7:00 pm
Tue 8:00 am - 6:00 pm
Wed 8:00 am - 6:00 pm
Thu 8:00 am - 6:00 pm
Fri 7:30 am - 6:00 pm
Sat 8:00 am - 1:00 pm
Sun 1:00 pm - 3:00 pm*

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Admission Form

Please complete all form fields below and click submit to send your information to us. PLEASE COMPLETE THE NIGHT BEFORE OR MORNING OF ADMITTANCE APPOINTMENT. This form is for Current Clients Only - New clients please use our New Client Form.
Owner's Name
Street Address
City, State, Zip
Pet Information:  
Pet Name
If Other Species
Pet's Diet and Activity:  
How often do you feed your pet daily? Once       Twice       Three times
Do you feed:
Drinkng Normal       Increased       Decreased
Appetite Normal       Increased       Decreased
Urination Normal       Increased       Decreased
Defecation Normal       Increased       Decreased
Procedure Questions:  
Did your pet eat after midnight last night?    Yes       No       
Is your pet taking any medication now?   Yes       No       
Is your pet allergic to any food or medication? Yes       No       
What is the best way to contact you to confirm the appointment? Phone       email

Has your pet had any illness/injury in the last year?

Yes       No   
Is your pet taking heartworm prevention
(e.g., Interceptor)? 
Yes       No   
Is your pet taking flea/tick prevention
(e.g., Frontline)?
Yes       No   
Would you like a microchip to be implanted today? Yes       No  
Please Check if any of the following has happened recently
Shaking of the head
Scooting of the rear
Straining to urinate
Bad breath
Behavioral changes
Unusual lumps/bumps
Unusual discharge
Lameness If yes, which leg?
Had a seizure in the past
Scratching Where?
Any weakness Where?
Anything else we need to know?
(read only)
When you are finished, click submit to send the form information