General Drop-Off Exam Form

patient_id

client_id

Administer flea preventative (Cost is based on pet's weight and brand used).**

Microchip ($65)-- Due to recent changes to City of Houston Laws, we must inform you that all pets are required to have a microchip that is registered with the City of Houston. This microchip replaces the physical licensing tag.

Additional services (check all that apply)

Authorization

YES, I approve all procedures, diagnostics, and treatments deemed necessary by the doctor to be performed today.

NO, call before ANY procedures, diagnostics, or treatments are performed. HOWEVER, I understand that a physical exam WILL still be performed by the doctor today before a phone call is made.

YES, I approve ONLY the treatments listed above and the following to be performed today:

General Drop-Off Exam Form

Sugar Land Veterinary Clinic

Name

Cell phone number for immediate contact today

Email Address

Pet's Name

Primary reason for today's visit