Tender Touch AH - Exam Drop-Off Form

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Tender Touch Animal Hospital
Exam Drop Off Form

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We may need to contact you regarding your pet. Please leave a number where you can be reached.* This field is required.

Home Phone Number

Work Phone Number

Other Phone Number

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Email* This field is required.

example@example.com

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Reason for Drop-Off

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We consider our hospital to be a flea free environment. If we see fleas on your pet, we will treat at a cost to you. (Initial)

The doctor will examine your pet during the day and determine a diagnostic and treatment plan. Expect a phone call regarding the findings and a plan later today from the doctor or technician.

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I authorize the exam and hospitalization currently. I understand that I will be charged the exam fee and a hospitalization fee. Pending the findings, I may thereafter choose to authorize diagnostics and or treatment as recommended.

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Signature* This field is required.

Clear

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Date

Tender Touch Animal Hospital Exam Drop Off Form

Tender Touch Animal Hospital
Exam Drop Off Form