Emergency: (231) 922-0911
Join Our Team
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Emergency: (231) 922-0911
Join Our Team
Home
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Our Story
Our Team
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Photo Gallery
Cat-Friendly Practice
Services
Resources
Our App
Payment Options
Emergency Contact
Online Forms
Photo Release Form
Dog & Cat Welcome Form
Chinchilla Welcome Form
Hedgehog Welcome Form
Rabbit Welcome Form
Rodent Welcome Form
Online Store
Online Pharmacy
Hill’s To Home
Contact
Companion Care Plans
Request Appointment
Home
About
Our Story
Our Team
FAQs
Reviews
Photo Gallery
Cat-Friendly Practice
Services
Resources
Our App
Payment Options
Emergency Contact
Online Forms
Photo Release Form
Dog & Cat Welcome Form
Chinchilla Welcome Form
Hedgehog Welcome Form
Rabbit Welcome Form
Rodent Welcome Form
Online Store
Online Pharmacy
Hill’s To Home
Contact
Companion Care Plans
Request Appointment
Please note: We will be closing at 12 PM on Tuesday, December 24th and will remain closed on Wednesday, December 25th for Christmas! We will also close at 12 PM on Tuesday, December 31st and remain closed on Wednesday, January 1st for New Years!
Hedgehog
Welcome Form
"
*
" indicates required fields
Owner's Name
*
First
Last
Owner's DOB
*
MM slash DD slash YYYY
DL#
*
Today's Date
*
MM slash DD slash YYYY
Spouse Name
*
Street Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
*
Cell Phone
Email Address
*
Spouse Phone
Work Phone
Employer
Emergency Contact Name
*
Emergency Phone
*
How did you learn of our hospital?
*
Internet
Facebook
Website
Other Veterinarian
Client Referral
Sign/Drive By
Phone Book
Other
Who referred you?
Pet Details
Hedgehog’s Name
*
Species/Breed/Variety
*
Sex
*
Male
Neutered Male
Female
Spayed Female
Weight
*
Date of Birth
*
MM slash DD slash YYYY
Color
*
Length of time in household
*
Do you have a second hedgehog?
*
Yes
No
Hedgehog’s Name
*
Species/Breed/Variety
*
Sex
*
Male
Neutered Male
Female
Spayed Female
Weight
*
Date of Birth
*
MM slash DD slash YYYY
Color
*
Length of time in household
*
Housing
Our Hedgehog has access to: (check all that apply)
*
Entire House
Yard
Fenced Area
Exercise Pen
Other Special Quarters?
*
Cage Size
*
length X width X height
Share cage with other Hedgehog?
Yes
No
Daytime temperature in enclosure:
Nighttime temperature in enclosure:
Other household pets:
Diet/Feeding
Hedgehog’s Diet:
Basic, primary food(s)
How often are those offered?
How long does it take to eat each portion?
Other Foods offered
How Often?
Hedgehog drinks from a...
Bottle
Bowl
History
Please list briefly any previous health problems, including when you noticed and when and how they were resolved:
*
Adverse reactions to medications?
Date of last fecal parasite test
Results of Test
Reason for today’s visit
If for illness or injury, please include date first noticed, changes observed during the problem, methods of treatment used (if any), and any other important, pertinent details
Authorization
*
I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet(s). I assume responsibility for all charges incurred in the care of this animal(s). I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment. I also authorize the hospital to use photos and/or other likeness of myself and/or my pet(s) for their medical record or other purposes. Must be 18 or older to authorize.
Signature of Owner
*
Date
*
MM slash DD slash YYYY
Method of Payment
Cash
Check
MasterCard
Visa
CareCredit
Discover
American Express
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.
