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Drop-off Admission Form

NOTE: Your pet will receive a physical examination today. We will call you to discuss our findings/recommendations and further estimated costs for services/diagnostics.

Is your pet on Heartworm Preventative?
Flea and Tick Preventative?
Is your pet currently on any medications?
Is your pet Diabetic?
Is your pet scratching, shaking head or scooting?
How is your pet feeling?
Coughing or Sneezing
Additional services requested today (check all that apply)
(indicate medication name, current dosage and quantity)
Authorization

1.  I authorize Metropolitan Veterinary Center to perform the procedures as indicated above.

2.  I understand the doctor will contact me after he/she has examined my pet to discuss tests, including x-rays and blood work with recommended treatments. I also understand that the doctor will be unable to proceed with any tests, including x-rays and blood work, or treatment until she has spoken directly with me and I have authorized this treatment and the charges associated with it. I also authorize the hospital staff, in an emergency situation, to perform any additional procedures necessary for the well-being of my pet until further communication with me. Payment is due at the time of discharge. I understand that follow-up examinations and additional treatments are not covered in today's price. I understand that no guarantee for successful treatment is made. Patients entering the hospital must be current on vaccinations unless here to receive today or medically contraindicated..

3.  I understand that I will be charged for administration of flea medication if evidence of flea infestation is found on my pet today.

4.  To the best of my knowledge the above information is accurate.

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