GreenTree Animal Hospital
Thank you for choosing us! Please fill out the following form before your scheduled appointment.
Please note: All * fields are required. If you have any questions, please call us at 847-680-6543.
We will need to be able to contact you or someone with permission to make medical and financial decisions.
If you are checking in for a surgical appointment please fill out our Surgical Consent Form .
In order for our doctors to do a complete analysis for diagnosis; do we have permission to perform the following if needed?
Please note: Pre-anesthetic bloodwork checks the internal organs and blood count and is a vital part of safe anesthesia. Help us provide the best level of care for your pet by choosing to perform bloodwork prior to anesthesia or sedation.
I, the owner/agent for the pet described above, request and authorize an exam for my pet. I understand that the staff at GreenTree Animal Hospital will contact me at the number listed above after my pet has been examined to discuss diagnosis and treatment and will have an initial estimate of charges.
I understand 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.