Emergency Check-In

EMERGENCY CHECK-IN FORM

To help us accelerate the check-in process, please complete this form and call our hospital at 250-933-0913 to ensure we’ve received your information. A member of our team will provide you with further instructions.

PATIENT INFORMATION

Pet Name *

Age in years *

Dog/Cat/Other *

If other, please specify.

Gender *

Breed *

Colour *

What is your emergency? *

This helps us prepare for your arrival.

In order to stabilize your pet do you authorize our team to perform what is necessary up to $500? This can include, intravenous catheter, pain control, fluids, x-rays, oxygen. *

Yes
No

In the event of a life-saving emergency:

Please perform CPR on my pet.
DNR (Do Not Resuscitate)

CLIENT INFORMATION

Owner's Name *

Email Address *

Address *

City *

Province *

Postal Code *

Cell Number *

Secondary Phone Number

Estimated time of arrival *

Vehicle Description *

Please provide your vehicle's make, model, colour, and/or license plate.

REGULAR VETERINARIAN INFORMATION

Do you have a regular vet clinic/hospital? *

Yes
No

Please verify that you are human *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *