Emergency Check-In Form

Please complete this form and call our hospital. A member of our team will provide instructions over the phone.

PATIENT INFORMATION

Has this pet been to WAVES before? *

Yes
No
I don't know

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Pet's Name *

Age *

Species *

Gender *

Breed *

Colour(s) *

Does this pet have insurance? *

What is your emergency? *

Who is the pet's primary veterinarian? *

Current or relevant history & medications: *

CLIENT INFORMATION

Have you been to WAVES before? *

Yes
No
I don't know

Name *

First

Last

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Cell Phone Number *

Email Address *

Are you the pet's primary owner? *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

I consent to the use and storage of my information in accordance with the terms and conditions detailed in the WAVES Hospital Privacy Statement linked below. *

I agree to the terms and conditions

View a copy of WAVES Hospital Privacy Statement HERE.

To verify you are a human, please answer the following math question: *

EMERGENCY SERVICES are open 24 Hours, 7 Days a Week

Emergency Check-In Form

PATIENT INFORMATION

CLIENT INFORMATION

Westcoast Animal Veterinary Emergency Specialty Hospital (WAVES)

Contact

Address

Hours of Operation