Hello, and welcome to Ann Arbor Animal Hospital! The COVID-19 epidemic has created a demand for an all-digital admission form.

If you’re a new client, please fill out the form below and click/tap “Submit” at the bottom when finished.

To give us time to receive and process your digital form, please wait at least 15 minutes before calling the hospital after sending it.

Also, please bring your pet’s records to your visit, or email them to us at clientinfo@annarboranimalhospital.com

COVID-19 Screening

  • I am not currently diagnosed with COVID-19
  • To the best of my knowledge, I have not (within the last 14 days) been in close contact with anyone diagnosed with (or suspected to have) COVID-19 (where ‘suspected to have’ means the person is exhibiting the principal symptoms of COVID, as described below, and ‘close contact’ is being within 6 feet for a cumulative 15 minutes or longer [within a given 24 hour period] OR providing care at home to someone who is sick with COVID-19 OR hugging/kissing an infected person OR sharing eating/drinking utensils with an infected person OR infected person sneezed, coughed, or otherwise got respiratory droplets on you). Note that this ‘close contact’ period begins 2 days before symptoms developed (for exposure to symptomatic individuals) or 2 days before the COVID-19-positive specimen was taken (for exposure to asymptomatic individuals).
  • In the last 10 days, I’ve simultaneously experienced no more than one of these principal symptoms of COVID-19 (doesn’t include symptoms due to known, non-COVID medical/physical condition): chills, muscle/body aches, headache, sore throat, fatigue (not otherwise explained by another known cause), diarrhea, nausea or vomiting, abdominal pain, congestion or runny nose.
  • During the last 10 days, I have not experienced any of the following principal symptoms of COVID-19 (not including symptoms due to a known, non-COVID medical or physical condition): fever(≥100.4 ºF), cough (excluding chronic cough due to a known medical reason other than COVID-19), shortness of breath or difficulty breathing, loss of taste or smell.
e.g. 2150 W. Liberty
e.g. 48103
e.g (734) 662-4474
(This is required by the DEA)
e.g. Michigan, Ohio, etc.
(This is required by the DEA)
(If you don't know, give your best guess)
(If you don't know, give your best guess)
e.g. brown, black and white, etc.
e.g. Wellness exam, vaccine, injury, etc.
If you have more than one pet, please enter their information here in a similar format (e.g. "Rex, dog, Chocolate Lab, born 4/15, age 5, brown color, neutered male")
Please provide your previous veterinarian's name and phone number so we can have your pet's medical records faxed to us (i.e. vaccine history, heartworm testing, etc.)
If desired, you may provide the name and phone number of one other person (trusted friend, family member, etc.) you authorize to order treatment or obtain patient information.
Please authorize treatment by entering your name and today's date in the box above. You are authorizing the release of your pet's medical records and will assume responsibility for all fees incurred. Note: All professional fees are due at the time services are rendered. Monies owed for services not paid at the time services are rendered are subject to billing fees and interest.