Drop-Off Form

Please complete this form before your visit.

*Please note: For the safety of our patients, all animals must be current on their biannual exam, vaccinations, and fecal testing in order to be dropped off. **This may be waived in certain situations.** In addition, all pets must be FREE of any internal or external parasites. Therefore, we will update anything needed or treat any parasites which might be found while your pet is here with us. Please note this may be an additional expense for which you will be responsible.

Name *

Pet Name *

***Pets should be picked up BETWEEN 5-5:30pm unless otherwise directed***

Reason for Drop Off/ Specific Treatment or Testing Needed: *

Current Medications and When Last Given (this includes Over the Counter and Prescription): *

Current Heartworm and Flea/Tick Medication and When Last Given (this includes Over the Counter and Prescription): *

Current Diet (include how often fed and how much) and When Last Fed: *

Any Other Concerns or Information that you would like us to know about your Pet: *

Proceed with all treatment/diagnostics as noted above *

Contact me after the Dr has examined my pet to discuss next steps *

Estimate needed prior to any treatment *

Phone Number Where You Can Be Reached Today: *