Online Medical Records

With AllyDVM you can log-in to see your pet's medical records, upcoming appointments and when vaccinations are due. You can also request an appointment or refill your prescription from your computer or mobile device.

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Refill

Request a prescription refill online.

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Pet Records
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Access your pet's medical records with the AllyDVM app.

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Financing Options

Badger Veterinary Hospital offers financing options for your veterinary care through CareCredit and Scratchpay.

CareCredit

The CareCredit card provides a flexible option for assisting in the payment of your veterinary expenses than traditional financing plans.

Apply Pay

Scratchpay

Scratchpay offers flexible payment plans for your pet's veterinary care, making sure you get approved and your pet's care is covered when you need it most.

Apply

Patient Forms

Click the toggles below to complete your form. If you’re submitting multiple forms, you must click submit after each completed form.

New Patient Form

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Authorized Agent Name

Email *

Primary Phone *

Mobile Phone

Work Phone

Address *

City *

State *

Zip Code *

Employer *

Occupation *

Date of Birth *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

Emergency Contact

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Do you authorize your emergency contact(s) to make urgent treatment decisions if you are unreachable? *

Yes

No

Do you authorize your emergency contact(s) to receive patient information in addition to your primary care veterinarians? *

Yes

No

Patient Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Presenting problem, special needs, concerns *

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Badger Veterinary Hospital to release patient information to the primary care hospital or veterinarian.

Primary Care Facility

Primary Care Veterinarian(s)

By submitting this form, I hereby authorize Badger Veterinary Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of the patient from Badger Veterinary Hospital.

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Dental Consent

First Name *

Last Name *

Email Address *

Phone Number *

Pet Name *

Special Instructions *

Extractions will be done if needed under doctor discretion. *

I have read and understand

Payment is expected at the time services are rendered. The balance is due before your pet is released from the hospital. We realize that veterinary services may become necessary at times that are financially inconvenient; therefore, we accept cash, VISA, MasterCard, Discover, American Express and Care Credit credit cards. In order to keep our veterinary costs to a minimum, we cannot extend the privilege of charging services as this puts us in the position of becoming a lending institution. *

I have read and understand

I am the owner (or authorized agent for the owner) of the above named animal and have the authority to execute this consent. I hereby authorize the above procedures by the clinic veterinarians and staff which may include diagnostic, therapeutic, surgical or preventative procedures and to administer sedation and/or anesthesia as deemed necessary. Further, I understand why such procedures are necessary, their advantages, and possible complications. No guarantee of successful treatment is made or implied.

I assume full responsibility for all charges incurred for this case and agree that payment of these charges will be made or arranged for before the animal is released. *

Yes

No

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Drop Off Consent

First Name *

Last Name *

Email Address *

Phone Number *

Alternate Phone Number *

Pet Name *

Species *

Breed *

Age or Date of Birth *

Sex *

Female

Spayed Female

Male

Neutered Male

Reason for Visit *

Please list any personal items that you are leaving with your pet

I, the undersigned owner/authorized agent of the above listed patient, hereby authorized Badger Veterinary Hospital - Janesville and its staff to administer veterinary care to my animal. I understand that an estimate of the fees for veterinary services can be provided to me prior to service and that I am encouraged to discuss all fees related to such care before services are rendered. I agree to assume financial responsibility for the care provided here. All patients are discharged at the end of each business day; I realize that I am responsible for arranging pick up of my pet prior to the end of the business day. If emergency treatment is required and I cannot be reached, I authorize that life preserving action be taken for my pet until I can be contacted. I agree to assume full and complete financial responsibility for the balance of ALL services rendered (we accept cash, Visa, MC, Amex ,and Discover) at the time my pet is discharged.

I assume full responsibility for all charges incurred for this case and agree that payment of these charges will be made or arranged for before the animal is released. *

Yes

No

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Surgery Consent

First Name *

Last Name *

Email Address *

Phone Number *

Pet Name *

Procedure *

Special Instructions *

Like you, our greatest concern is the well-being of your pet. There are always potential risks when undergoing anesthesia and/or surgery. To reduce risks and better ensure your pets safety under anesthesia, we recommend a blood profile and ECG reading be preformed prior. Abnormalities may not be detected unless these pre-anesthetic tests are completed. These tests are similar to those your physician would run on you.

Pre-anesthetic bloodwork gives the doctor more information regarding your pets organ function, alerting us to the presence of infection, anemia, dehydration, diabetes, kidney or liver disease. Our advanced, in- house equipment enables us to perform the pre-anesthetic blood profile the morning of your pets procedure.

Bloodwork completed in the last 60 days won't be repeated unless the doctor deems necessary. *Because of increased anesthetic risk, pre-anesthetic bloodwork is
REQUIRED for all patients 8 years and older*

The pre-anesthetic ECG can identify heart structure abnormalities and irregular rhythms.
Our ECG readings are electronically submitted to a cardiologist with results available within 30 minutes.

We will complete a mandatory therapeutic cold laser treatment following your pets surgery to provide accelerated healing and greater pain management. Therapeutic cold laser is NOT performed on the following surgeries: ocular, mass, lump or tumor removals.

Please select the pre and post surgery options you would like for your pet *

Please complete bloodwork recommended prior to anesthesia and/or surgery on my pet. If abnormalities are found, please contact me at the number below. **REQUIRED for all pets 8 yr and older**

Please complete the ECG screening recommended prior to anesthesia and/or surgery on my pet. If abnormalities are found, please contact me at number below.

I have elected to refuse the recommended pre-anesthetic testing at this time. I understand there is increased risks when using anesthesia or performing surgery on an animal that has not had the above testing.

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Standard Consent

First Name *

Last Name *

Email Address *

Phone Number *

Pet Name *

Procedure *

Special Instructions *

Payment is expected at the time services are rendered. The balance is due before your pet is released from the hospital. We realize that veterinary services may become necessary at times that are financially inconvenient; therefore, we accept cash, VISA, MasterCard, Discover, American Express and Care Credit credit cards. In order to keep our veterinary costs to a minimum, we cannot extend the privilege of charging services as this puts us in the position of becoming a lending institution. *

I have read and understand

I am the owner (or authorized agent for the owner) of the above named animal and have the authority to execute this consent. I hereby authorize the above procedures by the clinic veterinarians and staff which may include diagnostic, therapeutic, surgical or preventative procedures and to administer sedation and/or anesthesia as deemed necessary. Further, I understand why such procedures are necessary, their advantages, and possible complications. No guarantee of successful treatment is made or implied.

I assume full responsibility for all charges incurred for this case and agree that payment of these charges will be made or arranged for before the animal is released. *

Yes

No

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Grooming Consent

First Name *

Last Name *

Email Address *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Alternate Phone Number *

Today Contact Number *

Today Alternate Contact Number

Pet Name *

Species *

Breed *

Age or Date of Birth *

Sex *

Female

Spayed Female

Male

Neutered Male

Reason for Visit *

Please list any personal items that you are leaving with your pet

As per hospital and grooming protocol, please note that if it is discovered that your pet has fleas while here for grooming, a doctor recommended flea treatment will be applied at the owners expense *

I have read and understand.

I, the undersigned owner/authorized agent of the above listed patient, hereby authorized Badger Veterinary Hospital - Janesville and its staff to administer veterinary care to my animal. I understand that an estimate of the fees for veterinary services can be provided to me prior to service and that I am encouraged to discuss all fees related to such care before services are rendered. I agree to assume financial responsibility for the care provided here. All patients are discharged at the end of each business day; I realize that I am responsible for arranging pick up of my pet prior to the end of the business day. If emergency treatment is required and I cannot be reached, I authorize that life preserving action be taken for my pet until I can be contacted. I agree to assume full and complete financial responsibility for the balance of ALL services rendered (we accept cash, Visa, MC, Amex ,and Discover) at the time my pet is discharged.

I assume full responsibility for all charges incurred for this case and agree that payment of these charges will be made or arranged for before the animal is released. *

Yes

No

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Boarding Form

Before dropping your dog or cat off with us when they begin their stay, make sure to fill out either our canine or feline boarding intake form, depending on your companion. These forms give us the important information we need about your pet's health, temperament, needs and vaccination status before their stay with us.

Canine Intake Form Feline Intake Form
Payment Policy

First Name *

Last Name *

Email Address *

Phone Number *

Employer Name & Address *

Who may we contact, other than yourself, in case of an emergency with your pet?

Emergency First Name *

Emergency Last Name *

Emergency Phone Number *

Please list any persons other than yourself who have permission to consent to medical treatment for your animals:

All services MUST be paid for in full at the time of service, with NO EXCEPTIONS. This shall include routine health examinations, vaccinations, routine laboratory tests, surgeries, emergencies, perscription and non-prescription medicines, food and supplies. Payment may be made with Cash, Visa, MC, Discover, American Express and Care Credit. If payments are not received and the account becomes delinquent, the account will be subject to collections and/or legal action to enforce collection of money owed. If this becomes necessary, all expenses incurred in the collection of the debt including court costs and attorney's fee shall become the responsibility of the debtor in default. A service charge of $35.00 will apply in addition to the above, for any uncollected or returned checks.

I have read the payment policy above, I agree to the terms and will follow the guidelines of the agreement and acknowledge that I am fully responsible for the charges incurred in the treatment of my animal. *

Yes

No

I grant to Badger Veterinary Hospital, its representatives and employees, the right to take photographs of me /and or my pets, and to copyright, use , and publish the same in print and/or electronically. I agree that Badger Veterinary Hospital may use such photographs of me and/or my pets with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content. *

Yes

No

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Client Center

Online Medical Records

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Pet Records
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Financing Options

CareCredit

Scratchpay

Patient Forms

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

New Patients Welcome

Client Center

Online Medical Records

Request Appointment

Request Refill

Pet Records Sign-In

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Financing Options

CareCredit

Scratchpay

Patient Forms

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

New Patients Welcome

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Pet Records
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