Phone Number * Email * Pet's Name * Reason for Drop-off Appointment * If for an illness, how long have these symptoms been occurring? * Is your pet having any coughing/sneezing/vomiting or diarrhea? * Any exposures or ingestion of foreign objects? Any change in diet or treats? What kind of diet do you feed? Please list type, amount, frequency and when they last ate. * Is your pet having normal urination/defecation? * If your pet is a cat, does it ever go outside? Please list all current medications, dosage and frequency and when last given. (medications also include, preventatives, vitamins and supplements) * Are there any other services or medication refills you would like from us today? While in our care should anything life threatening occur with your pet, would you like us to perform CPR? * Please select from the following *
**Please note the physical exam fee is $75 if your pet is scheduled to be dropped off urgently
The nature of such service has been described to me to my satisfaction and I realize that no guarantee or warranty can ethically or professionally be made regarding the cure or result. I further recognize that there is an inherent risk of adverse reaction to any medication, including anesthetics, and vaccination that may be administered to my pet.
I understand that I assume financial responsibility for all services rendered, and that payment is due at the time the animal is released. A finance charge of 1.5% per month will be computed on all unpaid balances over 30 days. A fee of 33-1/3% will be assessed to all accounts that require outside collection services.