Drop Off Form

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Drop Off Form

Drop Off Form- *Also fill out the exam question form

* Indicates required field

Pet's Name *

First

Last

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Email *

Phone Number *

Reason(s) for leaving pet with us today: *

Examination-Sick Patient Examination- Wellness/Vaccine Appt Labwork Grooming

Is your pet experiencing any of the following? *

Vomiting Diarrhea Coughing Sneezing 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 *

Yes No

Should we call you *

*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 *

Submit

Please note that yearly wellness exams and vaccines are being scheduled 1 month out from requested date.

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