Hospital Admission Form

Hospital Admission Form

  • Client Information

  • Patient Information

  • Referral Information

  • Emergency Contact

  • I, the owner or authorizing agent of the patient and procedure described above, assume full financial responsibility for all charges regardless of the outcome of the patient's treatment.

    *Horses will not be discharged from the hospital until all paperwork and payment arrangements have been completed and signed. Any additional charges incurred during this are the owner's responsibility to pay.

Contact Us

4122 Zulla Road
The Plains, VA 20198

Phone: 540-364-4950
Fax: 540-364-4987

Phone: 540-364-4954

Location Hours for Equine
Monday8:00am – 5:00pm
Tuesday8:00am – 5:00pm
Wednesday8:00am – 5:00pm
Thursday8:00am – 5:00pm
Friday8:00am – 5:00pm

We are on call 24/7 for emergencies.