Bathing Drop Off Form First Name*Last Name*Pet's Name*Contact #*Additional Contact #BATHS INCLUDE: Comb-out (1st 15 mins), nail trim, ear cleaning. In order to bath your pets the undercoat must me completely removed. Additional combing will be charged at a rate of $5 per 15 mins.*IF FLEAS OR TICKS ARE FOUND ON YOUR PET AT THE TIME OF ENTRY, YOUR PET WILL BE TREATED AND THE MEDICATION WILL BE REFLECTED ON YOUR INVOICE UPON CHECK-OUT. *INITIAL**IF YOUR PET NEEDS OTHER SERVICES SUCH AS AN EXAM OR VACCINES TODAY PLEASE COMPLETE THE FOLLOWING SECTION Required vaccines are as follows: Canines- Rabies, Distemper/Parvo/Lepto and a intestinal parasite check, Felines- Rabies and CVRP. **VACCINE AND DIAGNSOTIC TREATMENT REQUESTED/REQUIRED SECTION (initial all that apply)**A PHYSICAL EXAM IS DONE AND CHARGED FOR WHEN REQUIRED OR REQUESTED VACCINATIONS ARE GIVEN. *INITIAL**Does your pet have any allergies to food or medications? Please list YES or NO and if YES please list details*Rabies VaccineDistemper/Parvo VaccineLeptospirosis VaccineBordetella (Kennel Cough)CIV -Canine Influenza N8 first strain (initials)CIV -Canine Influenza N2 newest strain (initials)Rattlesnake VaccineLyme VaccineCVRP (feline Distemper)FELV (feline Leukemia)Fecal (intestinal parasite test)Heartworm Test (recommended by DVM annually and required to get a refill on prevention)Please describe the problem(s) your pet is having, pertinent history leading up to the current condition, if any.What medication (if any) has your pet received in the last 24 hours? (TIME, DOSE, AMOUNT)PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PERFORMED. In admitting my pet for diagnostics and treatment, I authorize the veterinarians of Babcock Hills Veterinary Hospital, and their support staff, to administer such treatment and/or perform such diagnostic procedures as deemed necessary. I have read this authorizationDigital Signature*Date* NameThis field is for validation purposes and should be left unchanged.