DROP OFF HISTORY FORM
Please help us to take the best care of your pet possible by providing us with this important information. Thank you!
Pet’s breed and color:
Please mark any significant problem that applies to your pet:
Itching and/or licking skin
Shaking head or scratching ears
Please add any additional important details about your pet that we may need to know about your pet:
Please mark the option that describes your pet’s urine and bowel movements:
What type of food is your pet currently eating?
Has your pet’s food been changed in the past 2 weeks?
Does your pet ever get “people food?”
Where does your pet spend his/her time?
Mainly indoor, occasionally outdoor
Please describe any lumps or bumps that you would like to be examined:
Is your pet currently receiving a monthly intestinal and heartworm preventative?
Yes, every month
Yes, but occasionally missing a dose
No, not currently
Is your pet currently on any medication?
Please add any comments or questions you may have for the veterinarian:
Please add the best phone number at which you can be reached:
Thank you for allowing us to care for your pet today!
One of our veterinarians will examine your pet and call you as soon as they are able.
I hereby consent and authorize the staff of the Saraland Veterinary Clinic to receive, prescribe for, treat, sedate, or operate upon my pet. The undersigned agrees to make payment when services are rendered.
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