In Animal Hospital, most of the animals that walk up to your reception window are ordinary patients. A handful are not. These imposters wear a familiar face but carry tells you can catch if you know exactly what to look for. Reject them with the shutter before they enter, and you protect your patients and your Sanity. Let one slip through, and it becomes a Skinwalker that hunts you and everyone in the clinic.
Quick answer: Check every patient across three layers in order, in person, on the photo, and on the CCTV feed. The moment you confirm a single tell, hit the red shutter button on the left of your desk to reject them. One confirmed red flag in any layer is enough.
The three detection layers you must check
An anomaly rarely shows itself in just one place. The game spreads its tells across separate checks, and a patient that looks clean at the window can still be wrong on camera or in a photo. Run the same routine on every visitor instead of trusting a single glance.
| Layer | What it catches |
|---|---|
| In person (window) | Visual tells like extra eyes, sharp teeth, twitching, and unnatural grins. |
| Photo | Mismatches between the photo and the patient, static, and cursed images. |
| CCTV camera | Black censor bars, void bodies, stretched limbs, and patients staring into the lens. |
A patient can carry more than one tell at once. You only need one confirmed sign to reject. If every layer comes back clean, then admit them and move on to treatment.
Visual anomalies you can spot at the window
These are the fastest to catch because you do not need any equipment. Look at the patient’s face and body the moment they arrive. If any of these tells appear, reject immediately.
Three Eyes
The clearest tell in the game. Instead of two eyes, the patient has three glowing red sockets, often outlined by an orange glow. Three-eyed patients also carry a low-pitched, distorted voice. This is almost always an anomaly, so close the shutters without a second thought.
Mismatched Eyes and Sharp Teeth
This one pairs a crooked, distorted grin full of sharp teeth with two mismatched glowing eyes sitting at different heights. A low, warped voice is guaranteed. The whole face reads as wrong from the second the patient steps up.
Unnatural facial appearance (human or realistic teeth)
These patients lose their real face. One variant has big eyes with black pupils, heavy eyebags, and a large drawn-on smile. The other has small, wide eyes with black pupils paired with a set of realistic teeth. A full mouth of human-style teeth on an animal is an instant reject, and both variants come with a distorted voice.
Wide Eyes and Creepy Smile
An exaggerated expression with large, wide-open eyes and a disturbing smile. It is one of the more obvious window tells, so you can reject without bothering to check the camera or photo.
Hollow Face
This anomaly appears with pitch-black, empty eye sockets and is always seen twitching. Hollow Face is not always hostile, but do not try to treat it. During recovery it guarantees a Death Ritual, so rejecting it at the window is the safe play. A related entity with this look, the Head Banger, shows up later at the second check-in window.
Twitching
Rather than changing their face, these patients jerk their arms, neck, and upper body. The twitching can stretch the neck into an unnatural elongated shape. Movements are fast and easy to miss, so watch any suspicious patient for four to five seconds before clearing them. Twitching sometimes only shows up on CCTV, which is why the camera check matters.
Staring at the Player and Hunched Posture
A patient whose head constantly tracks your movement is an anomaly. To confirm, move behind it. A real patient’s head does not follow you when you stand behind it, so if the staring stops there, you have your answer. Hunched posture is a weaker tell that rarely appears alone. It usually rides alongside twitching or another sign, so reject it after cross-referencing.
CCTV anomalies that only appear on camera
Some imposters look completely normal at the window and in the photo. The only way to catch them is to switch to the lobby and check-in cameras. Distortions on the feed can re-randomize each time you reopen it, so checking twice is safer.
Censored Eyes
A large black censor bar covers the patient’s eyes on the feed, with a fake pair of eyes drawn onto the box. This look never belongs to a real patient, so reject on sight.
Unnatural Body
The body looks stretched, taller, or wider than it should, sometimes with limbs bending at impossible angles. The deformation often changes each time you reopen the camera. Reopen the feed a few times to confirm the shape keeps shifting, then reject.
Staring at the Camera
Normal patients face the hospital entrance. If one turns its head and looks directly into the CCTV lens, even while moving, you are looking at an anomaly. Reject it.
Void Body
These patients appear completely black on camera, with nearly every visible feature swallowed by the dark. It is one of the easiest CCTV tells to read because the silhouette is so plainly wrong.
Skinwalker on camera
Some Skinwalkers reveal themselves only on the security feed. Use the lobby camera to view patients from the side and watch for a wide-open mouth, sharp teeth, and a long hanging tongue. Their ears can also look wrong compared to a normal animal. This appearance usually is not visible when you look at the patient directly.
Note: One CCTV event is a trap rather than a patient tell. If the camera starts zooming toward a dark figure, look away from the feed. Staring drains Sanity fast and can be fatal if you keep watching.
Photo anomalies that show up after you snap a picture
If nothing stands out at the window or on camera, your last line of defense is the photo. Take the picture, then compare it detail by detail against the patient in front of you. Some differences are blatant, others are tiny.
| Photo anomaly | What to look for | Action |
|---|---|---|
| Different Eyes | Missing pupils, different eyelids, or changed eye shape compared to the patient. | Reject |
| Different Ears | Ears in the photo do not match the patient’s ears; sometimes subtle. | Reject |
| Incorrect Photo | A different animal entirely, or wrong fur color and markings. | Reject |
| Unnatural Photo | Human teeth, uneven eyes, a sharp-tooth grin, or a blurred face that only appears in the photo. | Reject |
| Static Photo | TV-like static and grain hiding the image. | Reject |
| Cursed Photo | Bloodshot eyes and an unnaturally wide grin. | Reject (costs Sanity) |
Cursed Photo is the one image with a built-in cost. Picking it up drains 10 Sanity, and that loss is unavoidable once you grab it. Read the photo while it is still on the desk rather than picking it up right away, and if you already caught a window tell, skip the photo entirely.
How to reject an anomaly and confirm it worked
If an anomaly slips through
Miss a tell and the patient becomes a Skinwalker once admitted. It can wake up at any point between check-in and the treatment rooms, then actively hunt you and your patients. You have a couple of ways to handle one.
- Use the taser next to the cameras, or any gun or extra taser bought from the shop, and land M1 hits to take it down.
- If it is attacking a patient, hold E from behind it to deal with it without taking damage.
- If it grabs you, press E repeatedly to break free, though you will lose Sanity doing it.
There is also a clean-up trick for missed anomalies. If an imposter reaches a treatment room, administering the wrong item kills it without costing you points, since only real patients dying lose points. It is a tidy way to remove one you let through by mistake.
The skill that carries you to the late shifts is memory, not reflexes. The game reuses the same categories of tells even as the specific animal changes, so once you know the baseline of a normal patient, the imposters stop blending in. Slow down, run all three checks on every visitor, and keep a coffee ready to top off your Sanity before risky moments. Do that consistently and you will reject skinwalkers long before they ever reach the clinic floor.
