Longenbaugh Veterinary Hospital

 

 

In order to expedite your check-in, you may fill out the form below.  You can print the form and bring it with you or you may submit the form directly from our website. By submitting a form directly from our website, you are agreeing that the form will serve as a signed form. Only an owner of the pet can give authorization for services.  If you wish more than one person to have the right to receive medical updates or make payment for services, this person must be listed on our records as an owner or a co-owner.  Thank you.  If you have any questions, please call us at 281-856-7023.
         
                                                                  

We at Longenbaugh Veterinary Hospital attempt to discuss all aspects of care with you; however, we cannot predict every circumstance or situation which may occur while your pet is hospitalized with us. We also cannot make any guarantees concerning results, treatment or outcome in regard to your pet’s care. If you need an estimate for the services your animal will be receiving, please ask the receptionist before the services are performed. Please understand that you will be responsible for any addtional charges for services if required for your pet (even if for the treatment of the same condition) additional expenses will occur, including hospitalization, sedation, medication, diagnostic tests, x-rays, and bandage changes.  Longenbaugh Veterinary Hospital is not a 24 hour facility.  We do not have patient monitoring during the hours that we are closed.  If your pet requires after hour care, we will refer you to the Animal Emergency and Referral Center of West Houston.  They will discuss their payment policy with you.   If you have any questions regarding the treatment and care of your pet, please do not hesitate to ask.
 
                                                                          
 

*Pet's Name
*Owner's Name

We ask that you fill in the name of the owner that is to be contacted about the medical condition of this pet. Please provide a contact number. To avoid confusion, we prefer to have one contact name. The name must be listed on our records as an owner.

You may have some one else drop off your pet, but all forms must be signed by you the owner or co-owner listed on our records.
*Contact Number
*Please explain the reason for your pet's visit.
Is your pet current on vaccinations?
Is your pet on medication?
List all your pet's medications.
I understand that if I need an estimate, I need to ask at the time my pet is dropped off. I also understand that all financial concerns I have or special payment arrangements are to be discussed before services are performed.

As owner I am responsible for all charges at the time of discharge. You may bring this signed form with you to drop off your pet or you may submit it directly from our website. By submitting the form, you are agreeing that you are this pet's owner and th
*Date
Signature for forms not submitted.