Drop Off Form

Date of Appointment

Owner Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Pet Name *

What is your pet being seen for?*

Primary Complaints (check all that apply)

Please describe if your pet has any unusual lumps, bumps, wounds, or skin irritation which you would like the doctor to address today. Please use the diagram below for reference.

Was your pet feed today?*

When was pet's last meal?

Type of food

Is your pet current on vaccinations?*

Any previous illness/surgery?

Type of Flea prevention

Type of Heartworm Prevention

What other medications is your pet on?

PLEASE REVIEW:

· Boarding/Grooming animals must have current vaccinations and be free of fleas and ticks at the owner’s cost.

· Owner authorizes the administration of any medications or anesthesia required for treatment or handling.

· Owner authorizes Sea Island Animal Hospital to do whatever is necessary in case of illness or emergency situation.

· Owner understands S.C. Law allows animals to leave more than (10) days beyond the agreed pick-up date to be considered abandoned and transferred to an appropriate animal shelter (R403; H4226).

· Owner authorizes sedation/anesthesia and understands that there are potential complications, including in rare cases death, associated with sedation/anesthesia.

· In surgical cases, pre-surgical lab work may be performed if necessary and pain management medications may be administered at the discretion of the doctor.

· Owner authorizes any and all of the above medical interventions/services to be done, at the Veterinarian’s discretion, should medical attention be needed.

Signature*

Would you like us to? (check one)*

Call after exam to go over estimate and recommendationsOnly call if treatment & diagnostics will exceed $250