Drop-off Form Client Name* First Last Pet's Name*Contact NumberDrop-off reasonWellnessIllnessOtherIf Other, ExplainWellnessCanine Rabies Bordetella Intestinal Parasite Screen Distemper/Parvo HW TestFeline Rabies Leukemia Intestinal Parasite Screen Distemper FIV/FELV TestDo you need more heartworm/flea prevention today?YesNoIf yes, how many months’ worth?What kind?IllnessOur veterinary assistants/technicians will gather information about your pet to report to our veterinarian.ServicesWhile your pet is with us, would you like any of the following services performed? Nail trim Ear Cleaning Anal gland expression OtherIf Other, ExplainSection BreakWhat to Expect: Your pet will receive a comprehensive physical exam by one of our Veterinarians. In most cases, diagnostic tests will be needed to fully determine the cause of your pet’s illness. Our team will attempt to contact you to discuss any needed diagnostic testing and provide a treatment plan. In the event that you cannot be reached, please note your wishes below:* I authorize a maximum amount for diagnostic testing and necessary medications. I do not authorize any diagnostic testing or services without prior consultation.Maximum amount of $*Signature*(Your digital signature (full name) is as legally binding as a physical signature.)Date
