Consent Form For Medical Services ***If your pet needs vaccines and/or diagnostics, this form must be completed in conjunction with either the Boarding Registration form, Dental authorization form, any Surgical release form, or Hospitalization form.*** ***For the protection of your pet, documentation of current proof of vaccines must be provided at time of check-in, unless we are administering them while your pet is here.*** Canine ***Requirements for: drop off appointment, surgery,dental***: Rabies, Distemper/Parvo, Leptospirosis, and a negative Fecal exam within the last 12 months. ***Requirements for boarding***: Rabies, Distemper/Parvo, Leptospirosis, Bordetella, Canine Influenza Bivalent, and a negative Fecal exam within the last 12 months. Feline ***Requirement-***For drop off appointment, surgery, dental, or boarding***: Rabies and Distemper (CVRP)Owner's Full Name*Pet's Name*Best Contact #*This is my...*CellWorkHomeWhat diet (brand/formula) is your pet on at home?*How much do you feed?*How often do you feed?*Lifestyle*Indoor SolitaryIndoor SocialIndoor/OutdoorStrictly OutdoorIs your pet current on Heartworm Prevention (what medication)?*Does your pet have any allergies to food or medications?*YesNoPlease provide allergy information**A physical exam is done and charged for prior to vaccinating when required or requested vaccinations are given. There is not a physical exam fee for the kennel cough vaccination when done alone.** ***EXAM,VACCINE AND DIAGNSOTIC TREATMENT REQUESTED (INITIAL ALL THAT APPLY)***Physical Exam (initials)Rabies Vaccine (initials)Distemper/Parvo Vaccine (initials)Leptospirosis (initials)Bordetella (Kennel Cough) (initials)Combo CIV-Canine Influenza (initials)Lyme Vaccine (initials)Rattlesnake Vaccine (initials).CVRP (feline Distemper)FELV (feline Leukemia) (initials)FELV/FIV TEST (Leukemia and Aids Test) (initials)Fecal (intestinal parasite test)Heartworm Test (recommended by DVM annually and required to get a refill on prevention) (initials)Pro Heart (initials)Do you need any medication refills? If yes, please list the name of the medication. *All requests subject to doctor approval*IF YOUR PET IS HAVING AN EXAM PLEASE LIST ANY CONCERNS THAT NEED TO BE ADDRESSED WITH THE DR.Digital Signature:*Date:*PhoneThis field is for validation purposes and should be left unchanged.
