Welcome Form Client information I authorize Hawthorne to send me text messages to receive lab results, surgery updates, etc. Standard text message rates may apply. Is Hawthorne your regular veterinary hospital? YesNo Please enter your regular vet's information Do you want us to send your pet's medical notes to your regular veterinarian? YesNo Where did you hear about our hospital? FacebookWebsiteOther Pet health history What type of pet do you have? DogCatOther Please select all that apply MaleNeuteredFemaleSpayed Are your pets rabies vaccinations current? YesNo Does your pet have any known allergies? YesNo What is the reason for your visit? Please check all the symptoms that apply BehaviorLack of appetiteSneezingBleeding gumsLimpingVomitingBreathingCoughingDiarrheaGaggingScootingWeakness/LethargicLoss of balanceScratchingIncrease in urination and/or thirstShaking head Authorization I hereby authorize the veterinarian (Hawthorne Animal Hospital) to examine, prescribe for, or treat the above described pet. I assume all responsibility of all charges incurred in the care of this animal. Please note that payment is required in full at the time services are rendered. Any charges not paid in full are subject to a 1.5% monthly service fee ($2.00 minimum). Any account turned over to collections will be responsible for any additional fees.