• Drop Off Questionnaire & Consent Form

    Thurman Veterinary Center

  • Please provide the following information so we can be certain that we understand your pets’ needs, it is very important for you to be as specific as possible. If we need additional information, we can reach you at the number you give us today. Thank you.

  • There is a place at the bottom of the form for you to add any additional infomation.  If your responses do not fit into the spaces provided, please add the answer to the additional information section.  

  • Date*
     / /
  • Has your pet been treated for the same condition recently?*

  • History:

  • Has your pet had any accident or injury in the past 30 days?*
  • Has your pet had surgery in the last 30 days?*
  • Is your pet allergic to any medication?*
  • Does your pet have their normal appetite?*
  • Has your pet been vomiting?*
  • Has your pet been experiencing diarrhea?*
  • Has your pet been listless (lacking energy or enthusiasm)?*
  • Is your pet drinking more or less water than normal?*
  • Is your pet urinating more frequently than normal?*
  • Does your pet show signs of weakness?*
  • Has your pet been coughing?*
  • Has your pet been sneezing?.*
  • Has your pet been gagging?*
  • Has your pet been scratching?*
  • Is your pet currently on flea control?*
  • Is your pet shaking their head?*
  • Is your pet limping?*
  • Is your pet scooting?*
  • Does your pet have a history of seizures? Or has had seizure recently?*
  • Does your pet have any unusual lumps or bumps?*
  • Does your pet have bad breath?*
  • Has there been a change in weight?*
  • Has your pet had any unusual discharge?*
  • Has your pet experienced any behavioral changes?*

  • Tests and Services Requested For Your Pet Today

  • Dog: Would you like to update vaccinations/tests today?
  • Cat: Would you like to update vaccinations/tests today?
  • Extras:

  • Some pets require sedation for adequate physical exam and/or treatments.

  • May we sedate your pet if necessary?*

  • After examination by the doctor, may we proceed with tests and/or treatments. 

  • Can we proceed with treatments/tests?*

  • If your animal is displaying signs of having fleas/ ticks/ worms and is found to be carrying them, we will AUTOMATICALLY treat the animal at a cost to the client. Thank you for understanding.

     

     

    Consent for Treatment and/or Admission

    I, the undersigned owner/agent of veterinarians at Thurman Veterinary Center. I also agree that after a consultation with me, the hospital’s doctor(s) may, consent to the examination of this pet by staff.

    prescribe medication, treat, hospitalize, sedate, anesthetize and/or perform surgery on my pet. I understand that some risks exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the veterinarian before beginning the procedure. Should unexpected life-saving emergency care be required and the veterinarian or staff member is unable to reach me, the hospital staff has my permission to provide such treatment, and I agree to pay all fees incurred. I understand that an estimate of fees for all veterinary services can be provided to me and that I am encouraged to discuss all fees related to the care before services are rendered and during my pet’s ongoing medical treatment. I understand that payment is due at the time of discharge. In some cases a deposit may be required.

  • Date*
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