Drop Off Form

I authorize Metro Paw Animal Hospital to release my pet to the following person in the event I am unable to pick up my pet:

Is your pet? (CHOOSE yes or no):

Treatment Authorization (Choose one):

Untitled multiple choice field

A

I DO, preauthorize veterinarian recommended diagnostics knowing that all payment is due at the time of service.

B

I DO NOT, preauthorize veterinarian recommended diagnostics knowing that all payment is due at the time of service.

Please confirm that you have read and understood the following by checking each statement below:

Untitled checkboxes field

I understand that my pet must be current on all vaccines (For Canine: DHLPP,RABIES, BORDETELLA, & INFLUENZA, for Feline: FVRCP, Rabies) and flea prevention.

I understand MPAH does not have attendants on site outside of normal business hours. On weekends and holidays, MPAH has staff come to the facility twice daily at minimum to service the animals.

The facility is not equipped with a fire sprinkler system, but the facility does have a security alarm, cameras, and fire alarm.

Would you like to be contacted by the Veterinarian?

A

Yes, via phone

B

Yes, at pick up (allow 30 minutes at pick up time to speak with Veterinarian)

C

No

Drop Off Form

Pet's Name

Owner's Name

Primary Contact Phone

Secondary Contact Phone

Name

Phone

Why is your pet here today?

Current medication (Including heartworm prevention):

Eating

Drinking

Vomiting

Diarrhea

Urinating

Change in water consumption

Would you like to be contacted by the Veterinarian?

What time would you like to pick up your pet by?

Signature of owner

Date