Internal Medicine Client Registration

Register for Your Pet’s Internal Medicine Visit
If your pet has been referred to Pet Emergency Clinic for internal medicine care, please complete the Internal Medicine Client Registration Form below.
The information you provide helps our internal medicine team prepare for your pet’s visit and ensures we have accurate client and patient information before their evaluation.
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Before You Visit

Please complete all required fields as accurately as possible. If you have relevant medical records, test results, or information about your pet’s current medications, please have those available for your visit.

Our board-certified internal medicine specialist works closely with primary veterinarians to evaluate pets with complex or ongoing medical conditions. Depending on your pet’s needs, their evaluation may include a review of their medical history, physical examination, and advanced diagnostic testing.

Submit Your Registration

Please complete and submit the Internal Medicine Client Registration Form below.

If you have questions about your pet’s internal medicine visit or need assistance with the form, please contact Pet Emergency Clinic.

If your pet is experiencing a medical emergency, do not wait for an internal medicine appointment or form response. Contact Pet Emergency Clinic or come in for emergency care right away.

Date and Time of Scheduled Appointment

Patient Information

Authorization for Services

By signing below, I certify that I have read and reviewed the above policies and that I have received and reviewed the procedures and policies handout for the internal medicine services.

Has your pet had any of the following signs?

Cardiopulmonary Resuscitation Status Election Form

ln the event your pet experiences a respiratory or cardiac arrest while in our care, cardiopulmonary resuscitation (CPR) can be administered based on the medical judgement of the veterinarians at Pet Emergency Clinic & Referral Center. CPR includes but is not limited to chest compressions, insertion of a breathing tube with manual ventilation, and administration of emergency drugs. The success of CPR depends on how advanced your pet's condition is.

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