Client Forms

If you need to fill out a form prior to your pet’s appointment, just use our convenient online forms provided. Make sure all required fields (marked with *) are complete and let us know if you have questions at (423) 357-4221.

New Client Form

New Client/Patient Form

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Pre-Surgical Lab Form

Pre-Surgical Lab form

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Last

Phone

Pet's Name

Your pet is scheduled for an elective dental or surgical procedure which will require anesthesia. There is inherent risk to the patient even under the best of circumstances, and some conditions can increase that risk considerably. Some conditions, most notably liver and/or kidney disease, may be discovered in early stages - sometimes long before any outward symptoms become evident. Your veterinarian does not require, but strongly suggests that your pet's blood be tested for abnormal chemistries and cell content prior to administration of anesthesia or subjection to surgical procedures. The findings often will alter the amount and types of anesthesia used for the safety of your pet and will afford a better indication of your pet's ability to safely undergo surgery. The findings will remain in your pet's record to be used for comparison should the need arise at a later date.

We prefer that the examination of your pet's blood be performed within 2-3 days prior to the scheduled surgery or dentistry. This allows your veterinarian time to begin any prophylactic treatments which may be needed for the health and safety of your pet before the actual dental or surgical event. Modern technology allows us to obtain the results of the tests within minutes of obtaining the blood sample, so if it is not possible to run the tests beforehand, they can be run on the morning of the scheduled procedure, allowing plenty of time for analysis before induction of anesthesia.

The following describes the standard "Profiles" we use for pre-anesthetic testing. You will note that the tests become more detailed as your pet ages. This is because the vitality of the internal organs normally decreases with age, and is the greatest single factor in determining the safety of anesthesia.

PRE-ANESTHETIC PROFILE: Pets less that 6 years of age
CBC - Complete Blood Count - Anemia, Infection, Clotting Ability
BUN, CREA - Kidney Function
TP - Total Blood Protein
ALT, ALKP - Liver Function
GLU - Blood Sugar

FULL DIAGNOSTIC PROFILE: Pets 6 years of age or older
CBC - Complete Blood Count - Anemia, Infection, Clotting Ability
BUN, CREA, PHOS - Kidney Function
TP, ALB, GLOB - Blood Protein
ALT, ALKP, TBIL - Liver Function
GLU - Blood Sugar
AMYL - Pancreatic Function
CA - Blood Calcium
Electrolytes - Sodium, Potassium

Bloodwork Authorization

I authorize MOUNT CARMEL PET HOSPITAL to perform the necessary evaluation of my pet's blood prior to anesthesia

I DECLINE authorization for pre-anesthetic blood testing. I am aware of the risk involved and accept full responsibility for this decision

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Elective Surgical Procedure Request

Name

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Last

Phone

Pet's Name

My pet has had a physical exam within the last year. If my pet has not had an exam in the last year, my pet will be examined the day of surgery. I am responsible for the cost of the exam.

I agree

My pet is current on vaccinations. If my pet is not current on vaccinations, surgery may be postponed until vaccines are given.

I agree

While my pet is under anesthesia, I give consent for the following procedures to be performed:

An injection for vomiting

Oral pain medication sent home with my pet. Some studies indicate that healing occurs faster when there is less discomfort following a procedure.

Removal of teeth, while getting a dental or for retained deciduous teeth. Cost of extraction depends on tooth and level of difficulty removing the tooth.

Place microchip for permanent identification.

Nail trim

Anal glands

I am the owner or authorized agent for the pet presented for surgery/hospitalization and have the authority to execute this consent. I have also been given an estimate of the cost of treatment and understand that payment is due when the animal is picked up.

I authorize

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Boarding Policy

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Last

Phone

Pet's Name

WE RECOMMEND MAKING RESERVATIONS 2-4 WEEKS IN ADVANCE

Your dog’s day starts at 8AM with a walk in our large outdoor fenced play yard. They are walked at least twice daily, and their quarters are cleaned, fresh water and food are supplied. All dogs are quartered in separate runs unless they are related and you request they stay together. Everyone is fed Purina EN to assure maximum nutrition. If your dog is on a special diet, please bring it with you. Prescription diets may be purchased. The exercise, cleaning, and feedings are maintained on weekends and holidays.

Your cat’s day starts at 8 AM with a fresh change of water, bedding, litter and a hearty meal of Science Diet, Royal Canin or Purina foods. Water, bedding, litter will be changed again in the afternoon. If your cat is on a special diet, please bring it with you. Prescription diets may be purchased.

*Please bring all necessary medications with your pet. Medications must be in the original container with a prescription label. We can refill medications. We will follow the dosing schedule for your pet.

*You are welcome to bring food, toys and treats for your pet. Please NO people foods, NO rawhides, nothing that can get stuck in your pet's mouth. It is possible any items left with your pet may not be returned. MCPH will not be responsible for lost items or items destroyed by your pet.

*We have bedding we will provide for your pet. Bedding is changed regularly. If you choose to bring bedding for your pet keep these things in mind: Bedding may become soiled. If time allows, we will launder these items, but they may be returned soiled. It is possible any items left with your pet may not be returned. MCPH will not be responsible for lost items or items destroyed by your pet.

*If you request your pet to have a bath before going home please plan to pick up your pet after 2pm Monday - Friday. This allows the kennel tech the time needed to bathe and dry your pet. If your pet is a Sunday pick-up the bath may be done on Friday due to time needed to give the bath.

*Canine Bordetella vaccine (kennel cough) given at another facility 6 months ago or longer must be given a booster before staying in the kennel.

*All boarders must be current on a yearly exam. If your pet is not current, we will do a boarding/brief exam and fecal check. Exam cost is $28.00.

*Collars and leashes will be removed while boarding.

*In the event your animal becomes ill while in our boarding facility, we will treat the animal appropriately at the owner/agent's expense.

*Fleas & ticks are unwelcome guests at our facility. Your pet must be on an active vet recommended flea control program given appropriately. If your pet is not on a vet recommended product, we will administer a recommended product at the time of admission to ensure a flea-free stay. This will incur a fee.

*If your canine family member is not on a heartworm preventative that controls the internal parasites whipworms, hookworms and roundworms, and evidence of internal parasites are found, the pet will be treated at the owner's expense.

*We require all animals admitted for boarding be protected against the basic communicable diseases. For dogs, those include DHPP (distemper, hepatitis (adenovirus 2), parainfluenza, parvovirus), Rabies and Bordetella. For cats, the basic FVRCPC (feline viral rhinotracheitis, calicivirus, panleukopenia, chlamydia) and Rabies. Feline leukemia vaccination is strongly recommended. Rabies vaccination is required by the state of Tennessee. In the absence of positive proof that such immunizations are current and administered by a licensed professional, we will administer basic vaccinations at the owner/agent's expense.

The hours for admitting and discharging are as follows:

Monday - Friday: 9AM to 4PM; Saturday: 9AM to 11AM

Please be advised:

Sunday pickup is pre-pay only and will include Sunday night charge. Sunday pickup is at 10AM only.*
No other weekend or holiday pickup is available.

Current daily fees for boarding are:
Cats………………………………………$23.00
Dogs 25lbs or less…………………$25.00
25.1 to 50lbs……………..$26.50
50.1 to 75lbs…………….....$28.00
75.1 and up………………….$31.00
Birds…………………………………….$23.00
Rodents, Exotics……………………………....$23.00
(rates are subject to change without notice)

Most of the boarding fees for animals represents the labor cost of handling, walking, feeding, watering and cleaning up after them. Therefore, a nightly boarding fee will be assessed for each night your animal(s) is in our care.

Run Dimensions:
• Large run 3’ x 6’
• X-large 5’ x 6’
• Bonus run 9’ x 6’

I have read and understand the policies listed above.

I have read and understand

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