Drop Off Checklist - Vet In Lebanon | Lebanon Animal Hospital

Date

Client Name

Home Phone

Number where you can be reached today

Emergency Contact and Number

Are you the:

If Other

Pet Name

Species

Age

Please check all symptoms that apply to your pet.

Where? Discharge

Color? Discharge

Where? Pain

Where? Growths

Please describe in further detail any symptoms marked above, including location:

How long has it had these symptoms?

Is your pet on any medication or dietary supplements?

If yes, please list medications below:

What type, brand, and approximate amount of food are you currently feeding?

What has your pet eaten in the last 48 hours?

I authorize Lebanon Animal Hospital to perform the following before notifying me:

Authorize Sedation

How much amount I authorize a maximum expenditure of ,Call before Sedating before the veterinarian consults with me

Drop-off Form