Patient Admission Form

Lakeshore Animal Health Partners Hospital in Mississauga, ON

If your pet is experiencing a medical emergency, call us at 905-858-6767 or bring them to our hospital immediately.

To expedite the admission process, please complete the form below before or upon arrival, if possible.

Your pet’s medical records will be forwarded to your family/daytime veterinary hospital after your visit.

Pet's Name *

Breed *

Do you want to provide your pet's age or birth date? *

Sex *

Colour *

Name of Primary Care Veterinary Hospital *

Is your pet insured? *

Yes
No

We offer direct billing with Trupanion for eligible insurance holders.

Reason for Visit: Please describe why you are bringing your pet in today. *

Please list all medications your pet is currently taking. If they are not taking any, indicate "N/A." *

Emergency Life Saving Authorization *

Yes
No

Should my pet's condition worsen, I wish for the veterinarian to perform CPR and other life-saving measures while trying to contact me. I agree to be responsible for the costs of such measures and understand that these measures may lead to costs greater than my initial treatment/procedure estimate.

FLEXIBLE PAYMENT OPTIONS

We know that unexpected vet bills can be stressful. That’s why we’ve partnered with LendCare, Scratchpay, and iFinance - trusted third-party financing providers that offer flexible payment plans (based on credit approval) and direct billing with our hospital for a smoother experience.

Patient Admission Form

Lakeshore Animal Health Partners Hospital in Mississauga, ON

Emergency Fee + Consult Emergency: $285 plus tax

OWNER INFORMATION

AUTHORIZED REPRESENTATIVE AND/OR EMERGENCY CONTACT INFORMATION

If I am not available, then the individual named above is authorized to:

PET INFORMATION

FLEXIBLE PAYMENT OPTIONS