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 H3N2, and a negative Fecal exam within the last 12 months. We also highly recommend canine influenza H3N8 for boarding as well, all though it is not required. If your pet (canine only) is boarding with us, should you elect not to vaccinate for CIV H3N8 (the original influenza), you will be asked to sign a waiver releasing Babcock Hills Veterinary Hospital from any liability should your pet become ill with CIV H3N8 while boarding. 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...*CellWorkHome**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)CIV -Canine Influenza N8-first strain (initials)CIV -Canine Influenza N2-newest strain (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)Does your pet have any allergies to food or medications? Please list YES or NO and if YES please list details*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.