Drop-Off Form

The information requested below will tell us what you want us to do for your pet.

It is 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.

Owner’s Name
Address
Is the address & phone number on the medical record above still correct?
Is your pet sick?
Has the pet been treated for the same condition recently?

Owner Release:

You are to use all reasonable precautions against injury, escape, or death. The clinic and staff will NOT be held liable for any problems that develop provided reasonable care and precautions are followed. I understand that ANY problem that develops while I’m absent will be treated as deemed best by the staff and veterinarians.

By signing below you assume full responsibility for expenses incurred for treatments and or medications given to your pet. If you neglect to pick up your pet within 5 days of the date below and do not notify us within that time frame we may assume that is abandoned and are hereby authorized to dispose of as you deem best and/or necessary.

We reserve the right to treat your pet with Capstar if fleas are found and I (owner) will be responsible for the $10.00 charge.

Sign above