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Hospital Admission Form

  • Client Information

  • Patient Information

  • Referral Information

  • Emergency Contact

  • I, the owner or authorizing agent of the patient and procedure described above, assume full financial responsibility for all charges regardless of the outcome of the patient's treatment.

    *Horses will not be discharged from the hospital until all paperwork and payment arrangements have been completed and signed. Any additional charges incurred during this are the owner's responsibility to pay.