Anomalies in Animal Hospital are fake patients that arrive at your check-in window disguised as ordinary animals. Admit one, and it eventually sheds the disguise inside the building, turning into a Skinwalker that hunts you and your real patients while draining your Sanity. The way to stop missing them is not faster clicking. It is running the same three checks on every single patient before you decide.
Quick answer: For each patient, look at them at the window, take and compare their photo, then pull up the CCTV. If any one layer shows a red flag, press the red shutter button on the left of the reception desk to reject them. Only admit when the window, photo, and camera all look clean.
Why rejecting beats admitting when unsure
The cost of the two mistakes is not equal. Wrongly rejecting a real patient only loses you that patient’s reward. Wrongly admitting an anomaly creates a Skinwalker, and every Skinwalker attack drains the Sanity meter shown in the corner of the screen. When Sanity reaches zero, the shift ends. So when a patient is borderline, lean toward closing the shutter.
Treat the checks as an OR test, not an AND test. One confirmed red flag in any single layer is enough to reject. You only admit when every layer is clean at the same time.
The 3 checks to run on every patient
Tip: Voice is a useful fourth signal but rarely enough on its own. A low-pitched or distorted voice paired with anything you spot at the window or on camera confirms the call.
Window red flags to reject on sight
These signs are visible the moment the patient reaches the desk, before you ever take a photo. Spotting one means you can drop the shutter immediately.
| Window sign | Action |
|---|---|
| Three glowing red eyes | Reject |
| Hollow black eyes | Reject |
| Human-like teeth or sharp fangs | Reject |
| Wide creepy grin | Reject |
| Head, hand, or neck twitching violently | Reject, or double-check on CCTV |
Photo red flags after you take the picture
This is where many players get caught early. Always take the photo and compare the face shape, ears, horns, texture, and expression against the patient standing in front of you.
| Photo sign | Action |
|---|---|
| Face shape or whole face does not match the patient | Reject and do not stare |
| Horn present in the photo but missing on the patient, or the reverse | Reject |
| Grainy, static texture on the photo | Reject |
| Bloodshot eyes and a wide grin (cursed photo) | Reject and do not stare |
Note: The cursed photo is dangerous by itself. Lingering on it costs you 10 Sanity, so check the photo as a habit but reject the instant you confirm a cursed one rather than examining it.
CCTV red flags only the cameras reveal
Some patients pass the window and the photo, then expose themselves on the security feed. Pull up the camera and look at the same patient one more time.
| CCTV sign | Action |
|---|---|
| Body is a complete black void | Reject before admitting |
| Box covering the eyes | Reject before admitting |
| Limbs or body heavily stretched or warped | Reject |
| Patient stares straight into the camera while walking | Reject |
| Patient appears in Skinwalker form on camera | Reject immediately |
| Body twitching with the head almost falling off | Reject immediately |
| Dark figure with red eyes zooms into frame | Look away and switch cameras |
The zooming dark figure deserves the most respect. Staring at it drains a large amount of Sanity and can be fatal if you keep watching, so look away or switch cameras the moment it starts moving toward the lens.
Don’t skip the paperwork
The medical records are the quietest tell and the easiest to overlook. Confirm the name, species, and appointment details match the animal at the window. If the records say dog but something else shows up, or the appointment does not line up, that single contradiction is enough to reject. Only admit when the window, photo, CCTV, and paperwork are all clean.
How to know the rejection worked
To reject, press the red shutter button on the left side of the reception desk. The window closes, the patient walks away, and your anomaly counter ticks up toward a better end-of-shift score. Once the shutter drops and the patient leaves, you can raise it again and move to the next one.
Solo and co-op detection
In co-op, split the duties clearly. Put one player on the window and shutter decisions, one on photo comparisons, and one watching the camera feeds. Pick a single caller so two players are not making opposite decisions at once.
Solo play means you run every check yourself, so slowing down is the correct play. The Secretary class passively recovers Sanity while you work the desk, and the Security class starts with a Taser in hand as insurance for the times something slips through.
What to do if an anomaly gets inside
Mistakes still happen. When an anomaly transforms inside a medical room, you will hear an audio cue. That is the signal to act fast.
Grab a weapon such as the Taser and approach the Skinwalker. Hold E to use the Taser, and keep pressing E if it grabs you, since the longer the grab lasts the more Sanity you lose. A Gun lets you handle it from a safer distance. If it moves room to room, prioritize keeping it away from patients you have already admitted. Tasing a real patient by accident costs some Sanity, but a single zap will not kill them.
There is also a quieter option. Anomalies that reach the treatment rooms can be killed by deliberately administering the wrong item during their treatment, which costs you no points. Build the habit of running all three checks before every decision and resist the urge to clear the queue quickly. Once that order becomes muscle memory, the night shift gets far easier to survive.
