405-631-7828

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Exam Fee $150 (does not cover diagnostics or treatment). Payment due prior to service.

CLIENT INFO

Name *

First

Last

Secondary Name *

First

Last

Address

Address Line 1

Address Line 2

City

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Zip Code

Primary Phone *

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Secondary Phone

Email *

PATIENT INFO

Name *

First

Last

Species *

Canine
Feline

Age/DOB *

Breed *

Color *

Weight *

Is your pet female or male? *

Female
Male

Is your pet spayed or neutered? *

Yes
No

Referring Veterinarian *

Reason for Visit *

CONSENT FOR EXAMINATION

This form acknowledges that I have authorized Animal Emergency Center (AEC) to examine my pet. I am aware that all expenses incurred during the diagnosis and treatment of my pet are required to be paid in full at the initiation of care with the Animal Emergency Center. If I decline treatment of said animal, I will not hold Animal Emergency Center or its staff response. The signature acknowledges your consent for the emergency exam fee of $150.00. If AEC feels that your pet is too aggressive for a regular examination and requires sedation, this consent will apply to charges for any sedation that is used during the examination. *

I have read and understand

AUTHORIZATION FOR CPR

Fees for CPR start at $600.00 and can increase based on the number of injections given and the weight of the patient. You can change this at any time, but YOU MUST LET AEC staff know so it can be changed. Animal Emergency Center may recommend your pet be hospitalized; in the event your pet(s) condition declines, AEC would like to know in advance the wishes of the family. *

I have read and understand

Do you want CPR for your pet? *

Yes
No

Signature *

Date *

Phone

Contact

T: (405) 631-7828
E: [email protected]

Location

931 SW 74th Street
Oklahoma City, OK 73139

Hours

Open 24 Hours A Day, 7 Days A Week.
Even Holidays!

Pet Visiting hours are from 10 am – 10 pm.

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