REYNOLDA VETERINARY HOSPITAL
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Drop Off Form
Drop Off Form- *Also fill out the exam question form
Indicates required field
Reason(s) for leaving pet with us today:
Examination- Wellness/Vaccine Appt
Is your pet experiencing any of the following?
None of the above
Please explain symptoms and when the symptoms was first noticed.
URINARY ISSUES IN CATS:
If necessary, it is OK to collect urine by cystocentesis-
By checking yes your are acknowledging that you are aware of the risks of obtaining a urine sample by cystocentesis.
Only for feline patients
Should we call you
If treatment exceeds $500
Treat without calling
If treatment exceeds another amount*
*If other amount please specify amount
For the safety of my pet, other clients, and of the staff, I understand my pet must be current on rabies, distemper, and bordetella (kennel cough), annual fecal examinations and free from external parasites. If my pet is not current or records are unavailable, I understand that they will be examined and the appropriate vaccines, lab work, and parasite treatment will be given. The described services and treatments will be in addition to all other charges. I also understand that all professional fees are due at the time services are rendered.
All drop off services will incur a drop off charge in the amount of $20.
By typing your name and date into the box below you are consenting the the above mentioned as well as any additional services that you chose.
Please enter first name, last name and date
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