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South Arlington Animal Clinic

Patient Drop Off Consent Form

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Patient Drop Off Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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Thank you for dropping off your pet with us today. The following information will be used to help our veterinary team complete your pet’s medical history for today’s visit.

Today’s date:

Pet Name *

We will need to be able to contact you or someone with permission to make medical and financial decisions. Who will we be speaking with? *

1st Phone *

2nd Phone_ *

Reason for visit

Vomiting
Diarrhea
Blood in stool
Coughing/sneezing
Difficulty breathing
Lameness or limping
Urination issues
Bite wound
Scratching
Hair loss
Lethargic
Not eating
Losing weight
Abnormal behavior
Check a growth
Check ears
Other:

Is your pet on any medications? If so, describe *

Should any unforeseen procedures be necessary and indicated in the veterinarian’s professional judgement, please select one of the following options:

I prefer you proceed with all necessary procedures.
I prefer to be called before any additional procedures. If I CAN NOT be reached, I DO authorize you to proceed with any procedures deemed necessary by the doctor.
If I cannot be reached by phone, I DO NOT authorize you to proceed with any additional procedures.

PET OWNERS SIGNATURE:

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We proudly serve the pets of Arlington, Grand Prairie & Mansfield, and surrounding areas. We look forward to seeing you and your pet! Book an appointment by clicking the button below.

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