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Drop Off Appointment Form

Drop-Off Exam Questionnaire

Client Information

Pet Information

Cat/Dog *
Male/Female *

About Your Pet

Please check the significant problems that apply to your pet:
Please indicate whether your pet is limping front/back and left/right.
Describe your pet’s urine and bowel habit:
What are you currently feeding your pet?
Have you recently changed their diet?
Does your pet has any lumps, bumps, cuts, sores that you wish to have us look?
Where does your pet spend his/her time?
Is your pet currently receiving a monthly intestinal and heartworm prevention?
In order to diagnose your pet’s condition, your pet may require blood tests, x-rays, and/or other diagnostic testing. Do you authorize tests if the doctor feels they are warranted? Please initial below:
Would you like to be called with an estimate prior to any treatment?

Acknowledgement and Signature

Drop Off Exams are offered for your convenience. Your pet will be examined when the doctor’s schedule allows (critical patients will be examined immediately). Pick up times cannot be guaranteed, but we will try our best to accommodate your schedule. Thank you for allowing us to care for your pet today! *

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