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Canine Drop-Off Registration Form

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

Owner's Name(Required)

First

Last

Pet's Name(Required)

Procedure(Required)

Date(Required)

Section I: Procedure Authorization

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

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

If I cannot be reached at the number provided, I authorize the veterinarian to treat my pet as they deem necessary for their well-being. I understand this may include additional expenses.

If I cannot be reached at the number provided, only provide the treatments listed above.

Section II: Parasite Control

For the protection of all our patients, any pet left for treatment will be inspected for external parasites (fleas, ticks, ear mites, 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. HomeAgainchips are known nationwide and have a 24 hour hot-line to match chip numbers with owner’s contact information. The cost of microchip implantation is $58.00.

Microchip Implantation

If your pet does not have a microchip and you wish us to implant one during their procedure, please check this box. The cost of the microchip is $50.00 in addition to the cost of the above listed procedures.

I assume financial responsibility for all services rendered and agree that payment is due when my pet is picked up.(Required)

Signature *

Date(Required)

Phone during the day(Required)

Animal's Possessions

May we have your e-mail address for Newsletters, Client Service Notes and Reminders? *(Required)

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Canine Drop-Off Registration Form

Section I: Procedure Authorization

Section II: Parasite Control

Microchip

Get in touch

615-822-1700

Business Hours

615-822-1700