Drop-Off Registration Form

Feline Drop-Off Registration

Please fill out the following form! If you have any questions, please feel free to contact us.

Feline Drop-Off Registration

To ensure your pet gets the best care we can offer, please fill out the form completely. Please Note: All * fields are required.

Feline Drop-Off Registration Form

Owner Name *

First

Last

Phone *

Email *

Would you like to receive updates for Newsletters, Client Service Notes and Reminders through email?

Pet's Name *

Animal’s Possessions

Procedure *

Procedure Date *

Please rest assured that your animal will receive the high quality care and attention their deserves as an important member of your family. If you have any questions or concerns during the day, please feel free to call our hospital.

Procedure Authorization

I hereby authorize performance of the procedures listed above. (If unexpected results are found which require immediate attention, veterinarian will call you to discuss treatment options.) *

If I cannot be reached at the number provided, I authorize the veterinarian to treat my animal as they deem necessary for their well being. I understand this may include additional expense.
If I cannot be reached at the number provided, only provide the treatments listed above.

Section II: Sedation to Reduce Stress

For some cats, the strange sights and smells of a veterinary hospital can be very stressful. In these cases we recommend a light, fast acting sedation which allows them to be examined and treated without the burden of stress.

If my cat displays significant signs of stress, I authorize the Doctors to administer sedation at an additional cost of $69.00

Parasite Control

For the protection of all our patients, any pet left for treatment will be inspected for external parasites (fleas, ticks, etc.). If parasites are found, we will apply the appropriate topical treatment at the single dose price. Please list any flea, tick or ear mite medication recently applied.

Microchip

Every two seconds, a family pet is lost. Many are never reunited with their families because they cannot be identified. Because of these statistics, we suggest microchips whenever a pet is sedated. HomeAgain chips are known nationwide and have a 24-hour hotline to match chip numbers with the owner’s contact information.

Our records indicate your animal ’s microchip number is:

No microchip?

My animal does not have a microchip, please implant one during their procedure. I understand  that the cost of the microchip is $68.00 in addition to the cost of procedure.
I hereby decline the implanting of a microchip.

I am the owner or responsible agent for the patient, and I have the authority to provide this advanced directive. I am over the 18 years of age. *

I have read and agree

I assume financial responsibility for all services rendered and agree that payment is due when my cat is picked up.

Owner/Owner’s Agent Name *

First

Last

Signature *

Today's Date *

Feline Drop-Off Registration

Feline Drop-Off Registration

Feline Drop-Off Registration Form

Procedure Authorization

Section II: Sedation to Reduce Stress

Parasite Control

Microchip

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Address

Contact Details

Hours

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