Owner's Name*

First Last

Pet's Name*

Mobile Phone*

Work Phone

I understand it is the policy of McGrath Veterinary Center to have my pet current on required vaccinations. Documentation must be provided before or at drop-off. If I am unable to provide documentation, my pet will be vaccinated upon intake and I will be responsible for the associated charges*

Please indicate the reason for your pet's visit and list any additional treatments or procedure you would like to have addressed today:*

We will perform a complete physical examination on your pet. After the exam, the doctor may find it necessary to perform diagnostic tests to better evaluate your pet. Please indicate by initialing which diagnostics the doctor may perform.

I authorize the doctor to take x-rays or perform an ultrasound. The cost varies based on the number of views taken.

I authorize the doctor to collect and submit any lab work necessary to aid in diagnosing my pet. The cost for the lab work varies depending on the test submitted.

I do not want anything besides the physical exam performed without my verbal consent.

To your knowledge, is your pet allergic to any drugs?*

Yes
No

Please list the drugs:*

Is your pet currently taking any medications, supplements or vitamins?*

Yes
No

Please list all medications, supplements and vitamins and the last time they were administered:*

Would you like a detailed estimate provided to you before any procedures are performed?*

Yes
No

We recommend taking all personal items with you upon drop off (leashes, collars, etc.) Please be advised we are not responsible for any items that may be lost or damaged.*

Date*

Signature*