Admissions

Name: Veterinary Specialists and Emergency Services
Address: 825 White Spruce Blvd., Rochester, NY, 14623, United States
Telephone: 585-424-1277
Price range: $

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Admissions Form

Please follow the below steps:

1. Call 585-424-1277 to alert us of your emergency.
2. Complete the Admission Form below prior to your arrival.

Owner Information

Client's Name*

Prefix First Last

Co-Owner's Name

Prefix First Last

Address*

Street Address Address Line 2 City State ZIP Code

Preferred Phone*

Co-Owner's Phone

Email*

Pet Information

Pet Name*

Species*

Pet Breed*

Coat Color*

Sex*

Female

Male

Spayed/Neutered*

Yes

Birthday or Approximate Age*

Medical Alert

(Medications/Chronic Condition/Allergies)

Medication Pet Is Currently Receiving

Pet's Veterinarian Name/Hospital*

(Place N/A if you do not have one)

Names Of Other Pets Seen At VSES Or Other MVA Hospitals*

Other

I am at least 18 years of age, and I accept financial responsibility for all charges incurred for medical services my pet receives. Should a doctor recommend hospitalization for surgery or other treatment, I will be presented with an estimate for charges that may be incurred during hospitalization. A monetary deposit that equals half of the high end of the presented estimate will be required. I understand that payment in full is due at the time my pet is discharged from the hospital. I authorize Veterinary Specialists and Emergency Services to release my pet’s medical information to the veterinarian(s)/ hospital(s) named above or any hospital where I may choose to receive follow up care for my pet.

Signature*

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Admissions

Admissions Form

Contact

Hours

Location

Continuing Education