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If your pet has an upcoming Ophthalmology appointment, please complete the specialty form using one of the options below. 

OPTION 1
Complete Online

Complete and submit the form below.

OPTION 2
Print & Complete

Bring the completed form with you.

Download PDF

OPTION 3
Complete on Arrival

If you prefer, you can complete the form when you get to our hospital.

Ophthalmology Patient Medical Questionnaire

Please answer the following questions to the best of your knowledge. 


Consent for Treatment

I understand that the estimated costs for medical or surgical treatment of this patient and the actual costs may vary. I certify that I am the owner or authorized agent of this animal and do authorize the examination, medical, surgical or other treatments as they are explained to me and are deemed necessary.
By submitting this form, I agree to the above.

From Our Clients

  • "On a late Saturday night, I was able to find this emergency vet for my cat. It was horrible seeing her in pain and miserable. We were able to get in quickly, the staff was all very friendly and came to let me know what was going on throughout the visit. They were up front about costs and gave me estimates for treatment. I felt respected, I feel my cat was very well treated and cared for!"
    Wendy O.

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