Drop-Off Testing/Procedure Form

Questions

Name*

First Last

Pet's Name*

Phone Number*

Current Meds and Date/Times Last Received:*

Has your pet had food this morning?*

Yes
No

Do you accept the basic treatments for any of the above problems selected?*

Yes
No

If X-Rays are necessary to treat your pet, do we have your permission?*

Yes
No

If bloodwork is necessary to treat your pet, do we have your permission?*

Yes
No

Do you accept sedation for your pet, if needed?*

Yes
No

Other Services Requested

I give permission for my pet to be treated for what is described above and I agree to be financially responsible for any services performed as agreed above.*

I give my permission.

Phone

This field is for validation purposes and should be left unchanged.

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Drop-Off Testing/Procedure Form

Questions

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