Admission Form - Medical

Our Admission Form – Medical

Save time during your upcoming appointment! Before your appointment, fill out the necessary documents online at any time from any device.

Admission Form – Medical

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

E.g Echo
Please ensure your pet is fasted from 8pm the night prior to surgery
If on medication what time was the last dose given
If yes, you do not need to pre-pay
Insurance Company Name, Policy Number and start date
This is the estimate that was given to you by the Vet/Receptionist

I understand that while every care will be taken. There is always some degree of risk involved with any medical or surgical procedure, and that I have discussed any concerns I may have with the veterinarian and hereby release, discharge and indemnify the veterinarian and any person or corporation associated with the hospital from all actions, suits, demands, claims, causes of action and costs of every description what so ever a law, equity and under the statute which i being the owner of this pet or person authorised by the owner, or any other person or corporation hasn, may have had or but for this consent could, would or might at any time hereafter have against the veterinarian or any person or corporation associated with the hospital in respect of or arising directly or indirectly out of the medication or surgical procedure.

I am also aware that full payment is required at the time my pet is discharged from hospital. In the case of extended hospitalisation/ treatment, further costs may be incurred, and it may become necessary for me to make further payments before my pets discharge date. The veterinarian on duty will inform me if this becomes necessary.

I the undersigned, being over the age of eighteen (18) and the owner of the above pet or a duty authorised agent, have read the above information and the terms and conditions (below), and do hereby give my consent for the above mentioned medical/surgical treatment, and any other procedure that should become necessary at Great Western Animal Hospital.


I certify that the above information is true and correct. I have read and understood the terms and conditions of trade (above) of Great Western Animal Hospital Pty Ltd which form part of, and are intended to be read in conjunction with this procedure admission form and agreed to be bound by those conditions. I authorise the use of my personal information as detailed in the Privacy Act clause therein. I agree that if I am a director/shareholder (owning at least 15% of the shares) of the Client I shall be personally liable for the performance of the Client's obligations under this contract.

I f you selected YES to GAPOnly you just need to exit out of the payment screen when redirected.