Sick Pet Drop Off Form

Sick Pet Drop Off Form
Pet Name *
Reason for visit *
Owner's Name *

First Name Last Name
Today's Date *

Month Day Year
Date
Canine/Feline Exam- $59 Exotic Exam - $73 Saturday Exam- $79 Emergency - $94
Procedures:

Skin Scraping ($35) Intestinal Parasite Screen ($31) Ear Cytology/Cleaning($30) Blood Work ($100-$250) Urinalysis($44) Aspirate/Cytology ($30) X-Ray ($160) Ultrasound ($50-450) Glucose Curve ($110)
Treatments:

Medical Injections ($20-$85) Bandage/Cast ($30-$80) SQ Fluids($40)
Extras:

Vaccines Updated Nail Trim($15) Bath (price is determined by weight)
If yes to bath, which one?

Basic All Inclusive
- Basic Bath (medicated or non) includes blowdry and brush out
- All Inclusive bath includes ear cleaning, Nail trim (grinding is an additional $5), and anal gland expression, bath, blowdry, and blush out.
  - Small ( < 30 lbs) $48
  - Large (>30 lbs) $48
Bath Extras:

Sanitation Shaving (feet, potty trail, face) Feet Shaving Only Shave Matts only Shave Down
Sedation?

Yes ($50-$85) No
If fleas are found on my pet flea prevention will be applied and will be charged to my account *

Clear
RELEASE/CONSENT SIGNITURE

I, THE UNDERSIGNED DO HEREBY CERTIFY THAT I am the owner, or assuming responsibility, financial or otherwise, for the animal being presented to Family Animal Hospital of Friendswood, PLLC for the treatment and care should it be needed while boarding my pet. I hereby consent and authorize Family Animal Hospital of Friendswood to recieve, perscribe, or treat, as indicated, this animal. It is thoroughly understood that I assume all the risk. Family Animal Hospital of Friendswood has I permission to do whatever is necessary should an emergency arise until I am reached.
In the unfortunate event that my pet should stop breathing or go into a cardiac arrest event for any reason, I would like CPR preformed on my pet. *

Yes (CPR) No (DNR)
Client Signature *

Clear
Best Contact Number *
Please enter a valid phone number.
Name for Number Given *

First Name Last Name
Are you an authorized representative over 18? *

Yes No
Who will be picking up your pet? *
Would you like an estimate? *

Yes No
Should be Empty:

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