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Drop-Off Admission Form

Save time during your next appointment. Complete your drop-off admission form online from any device at any time before your visit.

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Client Name *

Appointment Date *

Address

Address Line 1

City

State

Zip Code

Email *

Phone *

Email Reminders *

Daytime Name/Phone Number

(if different than above)

Reason pet is here: *

How long has this been going on? *

May we sedate your pet if the doctor deems it necessary? (additional Fee applies)

May we perform blood work/urine analysis if the doctor deems it necessary? (Additional fee applies)

May we perform x-rays if the doctor deems it necessary? (Additional fee applies)

Is your pet on any medications? *

Did your pet have any medication today? *

Does your pet go outdoors? *

Is your pet on flea medication? *

If my pet is found to have transmissible conditions (such as fleas, ticks, ear mites) I give my permission for treatment. (For the protection of all, patient cannot be admitted without this permission) (additional Fees apply) Please sign below.

Clear Signature

If your pet is not current on recommended and required vaccinations, I understand vaccinations will be administered today at the doctor's discretion (additional Fees apply) *

Clear Signature

(initial)

If your pet is not current on recommended and required vaccinations, I understand vaccinations will be administered today at the doctor's discretion (additional Fees apply) *

Clear Signature

(initial)

What brand of food do you feed? *

Grain free?

When did your pet last eat? *

If your pet is not microchipped, would you like us to implant one today for $54? *

Any additional questions or comments?

I understand that payment is due in full upon my pet’s discharge. My method of payment will be: *

Check
Debit/Credit Card
Cash
Care Credit Account

Signature *

Clear Signature

Date *

Message

Drop-Off Admission Form

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