Drop Off Patient Consent

As the owner and guardian, I request and authorise a physical examination of the below pet;

I understand that after examination the doctors will attempt to contact me to discuss recommendations for my pets care. The best number(s) to contact me today are as follows:

Immediate costs will not exceed designated amount per owner

I plan to pick up my pet at the following time today. I understand that an appointment has been scheduled for that time and the doctor/technician will go over instructions and results at that time. I understand that pending potential emergencies, there may be a wait at the time of pick up, but that every effort will be made to prevent that.

History Questionnaire


Current Diet

Medical Care

A copy of your completed form will be sent to your email address for future reference.