Tier list

Animal Hospital anomalies tier list

Use this ranked guide to see which Animal Hospital anomalies are the easiest to miss, which ones punish bad admits, and where each sign sits in the full 18 anomaly pool.

Last updated 2026-07-03

TL;DR

S tier means the hardest to spot trap tier anomalies.
Filter by category and sort by tier or spot difficulty.
The ranking covers all 18 Animal Hospital anomalies.
Each card links to the full anomaly page for more detail.

The full anomaly tier list

Filter by where the tell shows up, search for a specific anomaly, or switch the sort to line them up from hardest to easiest to spot.

Showing 18 of 18 anomalies

These tiers are our opinion, not game data. Nothing in the game ranks anomalies. S-to-C is our own judgement of how easy each one is to miss and how badly a mistake hurts, built from public community write-ups rather than an in-game audit. Disagree with a placement and you are probably not wrong.

S - trap tier

The ones that look almost normal or hide on a feed you were not watching. Miss one and the admit usually spawns something hostile.

Different EarsCCTVMedium riskCompare the ears in the photo AND on the feed - sources place mismatched ears in both, so treating it as camera-only will get one past you.S Different In PhotoPhotoMedium riskHold the photo next to the patient at the glass and compare ears, eyes, colour, and shape one at a time.S Human TeethAppearanceHigh riskEverything else reads normal, so check the mouth on every patient, not just the odd looking ones.S SkinwalkerCCTVHigh riskCCTV only. Watch the mouth open into rows of sharp teeth. Admit it and it turns hostile inside the hospital.S

A - tricky

Real tells, but subtle enough that a rushed shift skips them. Slow down here.

Black Body, Red EyesCCTVHigh riskOn camera the body goes black with red eyes and the feed zooms while your sanity drops. Reject on sight.A TwitchingAppearanceMedium riskHead, neck, and both arms jerk in short repeats. If the glass is unclear, confirm it on CCTV.A Twitching (CCTV)CCTVMedium riskSame jerky motion but it only shows on the security footage, so you have to switch feeds to catch it.A Cursed PhotoPhotoMedium riskThe photo itself is disturbing and costs 10 sanity the instant you look, so glance and close fast.A Deformed BodyCCTVMedium riskBody warping shows up only on the camera feed, never at the reception glass.A Photo StaticPhotoLow riskStatic or distortion crawls across the processed photo. Any noise on the image means reject.A

B - moderate

Clear once you know the sign, missed mostly when you are panicking on Shift 7.

Black EyesCCTVMedium riskA black bar sits over the face on CCTV with realistic eyes peeking through it.B Creepy SmileAppearanceMedium riskA wide unnatural grin with bulging eyes and heavy eye bags at the window.B Googly Eyes & Sharp TeethAppearanceMedium riskA distorted face paired with a warped, glitchy voice gives it away at the desk.B The StarerCCTVLow riskIt always faces the camera. Flip to another feed and it turns to look at that one too.B

C - obvious

Loud, obvious tells. You will almost never wave these through.

Head BangerAppearanceLow riskA hazard event, not a patient you admit or reject. It bangs its head on the reception glass; do not interact unprepared, it drains sanity while it waits.C Hollow FaceAppearanceMedium riskEmpty eye sockets and a lifeless, hunched, twitching stance. One of the easier appearance tells.C Three EyesAppearanceHigh riskA glowing red third eye on the forehead. Obvious to see, but admitting it spawns attacking monsters.C Void BodyCCTVMedium riskOn camera the whole body goes solid black. One of the simplest CCTV catches.C

How we ranked them

We ranked each anomaly by how easy it is to miss while scanning the patient at the window, the processed photo, or the CCTV feed. Small visual changes, symptoms that look almost normal, and signs that only appear on a camera you were not watching all rank higher.

We also factor in how badly a wrong admit punishes the run, since some anomalies just close the shutter while others spawn something hostile inside the hospital. This is our own shift judgement, not official game data, so treat it as a practical guide while you learn the patterns.

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