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188 East Main Street
Huntington, NY 11743
Tel: (631) 517-1773
Fax: (631) 517-1753
Emergency &
Critical Care
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Menu
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Menu
About Us
Who is VSCLI?
Mission & Core Values
Why Choose VSCLI ?
What is a Veterinary Specialist
About the VSCLI Patient Experience
Our New Hospital (Virtual Tour-photos)
Our Team
Meet our Team
Meet our Founders
Meet our Surgeons
Meet our Emergency Veterinarians
Meet our Support Staff
Practice Manager
Photo of the Team
Services
Orthopedic Surgery
Soft Tissue Surgery
Surgical Neurology
Surgical Oncology
Emergency Care
State Of The Art Diagnostics
Overnight Care
Cold Laser Therapy
In-House Laboratory
End of Life / Euthanasia / Cremation
For Pet Owners
Making an Appointment
Emergency Patients – What to Expect
Surgery Patients – What to Expect – for Consultation
Surgery Patients – What to Expect – on Surgery Day
Pre-Register BEFORE my First Visit (to speed up check in process)
Recognizing a Medical Emergency
Payment Options
Access VSCLI’s Medical Library
FAQ
For Veterinarians
Our Partnership & Commitment to the Primary Care Veterinarian
Veterinarian Service Request Form
Complete & Submit online
Download form (& fax or email)
Upload Patient Medical Records
Access the Patient Portal
Register as a Referring Veterinarian
Continuing Education at VSCLI
Careers
Join our Team
Hospital Tour
Virtual Tour
Contact & Location
Contact Us
Send Us a Message (email)
Making an appointment
Having an Emergency
Forms for Pet Owners
New Client Registration Form
Intake Form – Surgery
Intake Form – Emergency
Forms for Referring Veterinarians
Veterinarian Service Request Form
Providing Feedback about my Visit?
FAQ
VSCLI Surgical Intake Form
You can fill out the form here or download the online form by
clicking Here
"
*
" indicates required fields
Patient Name
*
First
Owner Name
*
First
Date
*
MM slash DD slash YYYY
Species (Dog/Cat)
*
Breed
*
Sex (include if spayed/neutered)
*
Color
*
Weight
*
Surgeon
*
Pet Insurance
*
Yes
No
Name Insurance
*
Insurance ID
*
CPR (Cardiopulmonary Resuscitation)
*
DNR (Do Not Resuscitate)
*
Please provide answers for all the following questions:
Please provide the best contact information to reach you
*
Please describe why your pet is here today? Or, which surgical procedure is being performed? Include location on the body, and if on the R or L side of the body.
*
Is your pet having any of the following?
*
X-ray
CT Scan
MRI
Surgery
Ultrasound
When did your pet last eat?
*
Is your pet currently taking any medications/ supplements? If so, please list them with the dosage.
*
When was the last medication/supplement given? (Day & time)
*
Does your pet have any medication allergies?
*
Does your pet have any food allergies or is on a prescription diet?
*
Are there any further health issues, or concerns, you would like to discuss with the surgeon?
*
Are there any special instructions we should be made aware of (ie: nervous with men, anxiety, sensitivity, etc)
*
Close Menu
About Us
Who is VSCLI?
Mission & Core Values
Why Choose VSCLI ?
What is a Veterinary Specialist
About the VSCLI Patient Experience
Our New Hospital (Virtual Tour-photos)
Our Team
Meet our Team
Meet our Founders
Meet our Surgeons
Meet our Emergency Veterinarians
Meet our Support Staff
Practice Manager
Photo of the Team
Services
Orthopedic Surgery
Soft Tissue Surgery
Surgical Neurology
Surgical Oncology
Emergency Care
State Of The Art Diagnostics
Overnight Care
Cold Laser Therapy
In-House Laboratory
End of Life / Euthanasia / Cremation
For Pet Owners
Making an Appointment
Emergency Patients – What to Expect
Surgery Patients – What to Expect – for Consultation
Surgery Patients – What to Expect – on Surgery Day
Pre-Register BEFORE my First Visit (to speed up check in process)
Recognizing a Medical Emergency
Payment Options
Access VSCLI’s Medical Library
FAQ
For Veterinarians
Our Partnership & Commitment to the Primary Care Veterinarian
Veterinarian Service Request Form
Complete & Submit online
Download form (& fax or email)
Upload Patient Medical Records
Access the Patient Portal
Register as a Referring Veterinarian
Continuing Education at VSCLI
Careers
Join our Team
Hospital Tour
Virtual Tour
Contact & Location
Contact Us
Send Us a Message (email)
Making an appointment
Having an Emergency
Forms for Pet Owners
New Client Registration Form
Intake Form – Surgery
Intake Form – Emergency
Forms for Referring Veterinarians
Veterinarian Service Request Form
Providing Feedback about my Visit?
FAQ
188 East Main Street
Huntington, NY 11743
Tel: (631) 517-1773
Fax: (631) 517-1753
Emergency &
Critical Care