Drop-Off Exam Questionnaire

Complete your drop-off form online! If you have any questions, please call us directly at 702-242-9044.

Name *

First

Last

Email *

Pet's Name *

Drop-Off Date *

Pick-Up Date *

What do you need performed on your pet today?

Exam
Boarding
Vaccines
Bath

If Other, please explain:

Describe your pet's eating habits:

Normal
Increased
Decreased

Describe your pet's drinking habits:

Normal
Increased
Decreased

Describe your pet's urine habits:

Normal
Increased
Decreased

Describe your pet's stool habits:

Normal
Soft
Diarrhea

Please tell us about your pet's diet - wet food or dry food? Brand? Feeding amount and frequency? How long has your pet eaten this food?

Where does your pet spend his/her time?

Only Indoor (never outside)
Equally Indoor/Outdoor
Mainly Indoor
Mainly Outdoor

Is your pet current receiving any other medications? Please list medications and daily doses.

Please list any other comments or questions you have for the doctor:

In order to diagnose your pet's condition, your pet may require a blood test, x-rays, and/or other diagnostic testing. Do you authorize tests if the doctor feels it is warranted?

Do what is necessary
Call with estimate prior to any treatment

Please check any additional services that you would like performed while your pet is in the hospital:

Nail Trim - $10
Anal Gland Expression - $10
Bath - $15-23 (depending on size)

It is very important that the doctor is able to contact you if he/she has questions regarding your pet. Failure to be reached may result in postponement of treatment. Please list a main and alternate phone number that you can be reached out today:

Drop-off exams are offered for your convenience. Your pet will be examined when the doctor's schedule allows. Critical patients will be examined immediately. Pick-up times cannot be guaranteed. There is a $5 fee for drop-offs (excluding boarding and baths). *