Talega Animal Hospital - Medical Information Sheet

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It is so important that we understand your medications before you leave your pet with us. Even if you received the medications from Talega Animal Hospital – you need to fill this form out.

This will take an additional 2-5 minutes depending on how many medications your pet is currently taking. Thank you for understanding.
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Pet Name
Client Last Name
Dates Boarding
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Please alert Receptionist if Rx bottle label & your directions are different.
Name of Medication or Treatment to be given
mg
Dosage to be given
Given how many times a day? ( 1x 2x 3x 4x )
LAST DATE & TIME pet was given this Rx
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2
3
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Name of Medication or Treatment to be given
mg
Dosage to be given
Given how many times a day? ( 1x 2x 3x 4x )
LAST DATE & TIME pet was given this Rx
Name of Medication or Treatment to be given
mg
Dosage to be given
Given how many times a day? ( 1x 2x 3x 4x )
LAST DATE & TIME pet was given this Rx
Name of Medication or Treatment to be given
mg
Dosage to be given
Given how many times a day? ( 1x 2x 3x 4x )
LAST DATE & TIME pet was given this Rx
Name of Medication or Treatment to be given
mg
Dosage to be given
Given how many times a day? ( 1x 2x 3x 4x )
LAST DATE & TIME pet was given this Rx
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Additional information you would like us to know
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Fee to medicate: Once per day $5.00. Twice per day $8.00. Three times per day $11.00. Four times per day $15.00.

I understand that EACH TIME my pet boards at Talega Animal Hospital – I will need to fill out a new Med Info Sheet.
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Client Signature* This field is required.
Clear
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Today’s Date* This field is required.
Date
Year
Month
Day
Should be Empty: