Open 7 Days a Week - Including Saturday & Sunday

Emergency Intake Form for Dogs & Cats

If your pet is receiving emergency veterinary care at Carolina Veterinary Specialists, please complete the emergency intake form below.

Date

Pet's Name

If you are waiting to be seen, please fill out this form while waiting to be triaged by one of our veterinary technician/assistants. Be prepared that our wait times can vary with the wait time originally given. We are an emergency room, and we often see patients with severe, life-threatening conditions. We also see plenty of patients with urgent issues, but sometimes they have to wait if we are trying to save another pet’s life. If possible, make an appointment with your family vet for non-urgent care. Remember, if you are waiting for your pet to be seen, that is a good sign. If your pet is bumped to the front of the line that means they are very sick and need immediate care.

Please be kind and considerate to our staff. We are here to help you and your pets. That is our passion and what we have all dedicated our lives to, even with the pain and trauma that goes with it. We understand your fear and frustrations, but we will not tolerate people screaming, threatening, or abusing our staff. All of the medical world is overwhelmed and overworked right now, and that includes everyone in veterinary medicine. We are doing the best we can with what little resources and staff we have. If you cannot be patient and compassionate with us, we will not be able to help you or your pets.

Thank you for understanding. We appreciate everyone who offers us understanding and kindness while we work to help you and your family.

Pet’s primary care veterinary clinic

Please list your primary reason for visit today

When did you first notice the concern?

Has the concern improved, remained the same, or worsened since you first noticed it?

Have you had any diagnostic tests done elsewhere? If so, where?

Any previous injuries, illnesses or surgeries?

Any vomiting, diarrhea, coughing or sneezing?

Urinating and defecating ok? Normal consistency and amount?

Eating and drinking ok? Have you noticed any changes in their eating/drinking habits?

History of eating things they shouldn’t? Anything they could have gotten into?

Is their activity level normal?

What is their lifestyle like? (Indoor, outdoor, parks, beaches, hiking, grooming, boarding)?

Does your pet travel? If traveling, where to?

Flea/heartworm/tick prevention or supplements?

Up to date on vaccines?

Yes

List any prescription medications your pet is currently taking (please include frequency and dose given [i.e.: 1 tablet twice a day])

When were the medications last given [ie: last night at 6pm, this morning at 8am]?:

What does your pet eat? (food, treats, dental care, human food, etc.)

Any known allergies to food, medications, environmental, etc.? If so, explain:

Do we have permission for the following?

Emergency exam fee $195

Emergency treatment if your pet is in critical condition (IV catheter, IV fluids, pain medication, antibiotics, etc.) $600-800

Bloodwork (complete blood count, serum chemistry, electrolytes or blood gas analysis) $80-$300

X-rays (Chest or abdomen) $325-600

IV catheter placement and starting IV fluids $200-300

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Emergency Intake Form for Dogs & Cats

Caring for Pets in Huntersville