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Technician Appointment: Check-In Form

Sugar Land Veterinary Clinic

Contact's Name

*

Contact's Cell Phone Number

*

Contact's Email Address

*

Pet's Name

*

Is this a pre-op/post-op visit?

*

Is this a pre-op/post-op visit?

A

Yes

B

No

Services requested today (check all that apply)

*

Services requested today (check all that apply)

Nail trim

Anal gland expression

Vaccines

Bloodwork/laboratory testing

Technician recheck/suture removal

Medication administration by technician

Sanitary trim

Medicated bath (includes ear cleaning, nail trim, and anal sac expression)

Grooming* (*if sedation is required to complete, then examination by the doctor will be performed first)

If required, was the patient fasted for bloodwork?

*

If required, was the patient fasted for bloodwork?

A

Yes

B

No

Was your pet given any medication in preparation for today's treatment?

*

Was your pet given any medication in preparation for today's treatment?

A

Yes

B

No

Any questions or concerns regarding the requested treatment today?

I approve/understand the treatment(s) as requested above, and I have been able to discuss any questions with a technician/doctor on or prior to the date below. This includes the cost of today's treatment which may include a $10 Technician Examination fee.

Today's Date

*

Signature

*

Signature