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Drop off Consent Form

Please note: Drop off patients require at least (1) in-person exam within the past 12 months to quality for this service.

Owner's Name *

Owner's Name

First

Last

Email *

Pet's Name *

Reason for Visit *

Health History

Has your pet eaten this morning? *

Yes

If no, when was their last meal? *

Has your pet been vomiting? *

Yes

If yes, for how long?

What are they vomiting?

Has your pet been experiencing diarrhea? *

Yes

If yes, for how long?

Has your pet been lethargic? *

Yes

If yes, for how long?

Has your pet been coughing or sneezing? *

Yes

If yes, for how long?

Is your pet on any medication that we have not prescribed? *

Yes

If yes, what and at what dosage?

By dropping off, you authorize the doctors at Sahara Pines Animal Hospital to treat your pet as deemed necessary. In order to allow necessary diagnostics and or treatment, we required a minimum allowance of $250. This does not mean this will be the cost of your visit.

While your pet is here we may require to run the following tests: Blood Panel, Xrays, Urinalysis. May we perform what is deemed necessary? *

Yes

Please list the charge amount at which you would like us to call you before exceeding *

Should any problem arise while your pet is in our care today… *

Perform any procedures as needed.

Please call me.

Do only what has been authorized. By selecting this option you understand that your pet may require additional procedures in the future to complete their treatment.

I will be available at the following number

If for some reason you can not contact me… (select one)

Perform any procedures as needed

Do only what has been authorized

I am the owner or agent of the pet named above. I consent and authorize the performance of the doctor recommended procedure(s). I have been informed of the reason for the treatment/procedure(s), along with the expected benefits and risks involved. *

I Authorize

I understand that there are certain risks to anesthesia and/or sedation that could involve serious bodily injury or death and that these risks are present in any procedure that requires a general or intravenous anesthetic or sedative. I consent to the use of anesthesia and/or sedation as needed for my pet. *

I Authorize

I understand that unforeseen conditions may required an extension of a planned procedure. I hereby authorize the performance of such procedures or operations as are necessary and advisable in the professional judgment of the Veterinarian. *

I Authorize