VS Equine Admission Form Δ InstagramThis field is for validation purposes and should be left unchanged.Owner Name(Required) First Last Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 Horse's Name(Required)BreedAgeColourColour/MarkingSexMareGeldingStallionMicrochip/Id numberReason for Admission Dental Procedure Medical Treatment Bandaging Radiology Foaling Joint injection Gastroscope Ai Fresh/Frozen Branding Rehabilitation Vaccinations Lameness work up +/- Sleip Microchipping Ultrasound pregnancy/tendon Pre Purchase Examination Health Examination Surgery Other Terms and Conditions(Required)I, the undersigned owner or authorized agent of the above-named horse, hereby consent to the admission of my horse to VS Equine Facility and authorize the facility and its staff to perform the necessary procedures as marked above or as deemed appropriate by the attending veterinarian. I understand that: •All procedures carry inherent risks, including but not limited to complications, injury, or death. •The facility will take all reasonable precautions to ensure the safety and well-being of my horse. •I am responsible for all costs incurred during the horse’s stay, including emergency care if required. •I will be contacted prior to any non-emergency procedures or changes in treatment plans. I confirm that I have read and understood the terms outlined above.General anaesthesia or sedation is required for procedure Yes No Terms and Conditions(Required)If general anaesthesia or sedation is required: 1)This procedure has been explained to me and I understand there are possible risks and complications involved, including but not limited to anaphylaxis, myopathy, neuropathy, limb fracture, respiratory or cardiovascular complications, haemorrhage and death. 2)I understand that the administration of general anaesthesia or sedation is required. 3)I have notified the veterinarian of any known pre-existing conditions or risk factors that may affect general anaesthesia or be relevant to the procedure to be performed. 4)If any unforeseen complication occurs during or after the procedure, the veterinary team may need to perform additional treatments, emergency surgery, or otherwise to stabilise your horse. I authorise the attending veterinarian to perform such emergency procedures as are judged necessary in their professional opinion. 5)If refusal of emergency care could result in severe suffering or death, the veterinary team will inform the owner/ representative if possible, but may act immediately to prevent undue suffering. I accept and understand that: 6)I am financially responsible for all charges associated with the procedure, medications, diagnostics, and any additional emergency treatments required as a result of complication. I hereby give permission for general anaesthesia or sedation to be performed by the Veterinarian, in respect to the above animal and the above procedure. I agree to meet payment of all treatment on the day of the procedure unless prior arrangements have been made. I understand that there I confirm that I have read and understood the terms outlined above.Date of last vaccination MM slash DD slash YYYY Type of vaccinationDate of last drench MM slash DD slash YYYY Type of drenchEmergency Authorisation(Required)In the event of an emergency where I cannot be reached, I authorise the facility to make decisions regarding the care and treatment of my horse, including surgical intervention, emergency first aid and under extreme circumstances, euthanasia (if deemed necessary). I authorise emergency decisions as outlined above. I do not authorise emergency decisions without prior contact. Insurance CompanyPolicy NumberContact NumberAcknowledgement of Risk and Liability(Required)I acknowledge that equine care involves risks and that the facility, its staff, and affiliated veterinarians will not be held liable for any injury, illness, or death of the horse except in cases of gross negligence. I understand that there isn’t always a staff member on site for the full length of stay. I agree to indemnify the facility from any claims arising from the horse’s stay. I confirm that I have acknowledged the aboveDischarge(Required)If your horse is not collected before 5pm, the facility will be closed and you will be charged for another days adjustment and wait until 8am the follow morning. There are no exceptions to this rule. I confirm that I have acknowledged the aboveDischarge Date MM slash DD slash YYYY Discharge time Hours : Minutes AM PM AM/PM Patient's items left on site(Required)FloatHalterLeadCoverFeedOtherAdditional InformationI confirm that all information provided is correct YesOwners Name First Last Date MM slash DD slash YYYY Share this post Share on FacebookShare on Facebook Share on XShare on X Pin itShare on Pinterest Share on LinkedInShare on LinkedIn Post navigationPreviousPrevious post:Tune In: Vet Services Equine Podcast – LaminitisRelated NewsTune In: Vet Services Equine Podcast – Laminitis23 April 2025VS Equine is now partnering with HorseSafe.1 March 2025Strangles Outbreak Update3 February 2025