Pet Drop Off Form - Bayside Animal Hospital

Golden retriever Dog smiling from inside car, open window, being dropped off

Please use the form below to tell us about your pet prior to drop-off.

Drop Off Agreement Form

Owner's Name(Required)

First Last

Email(Required)

Phone(Required)

Alternate Phone

Pet's Name(Required)

Name

Reason for Visit

Belongings

Please select one of the following options:(Required)

I authorize testing and treatment deemed necessary by the doctor and place no limit on charges and services.

I authorize testing and treatment and approve charges up to the amount specified below. Please call me if any additional procedures are necessary beyond this amount. I understand that if I cannot be reached, NO treatments, except in an emergency situation, will be performed.

I wish to be called before any testing or treatments, beyond an exam ($70.00), are performed.

I authorize testing and treatment and approve charges up to ($ amount)

Extra Services

Annual Preventive Care

My pet is in need of annual preventative care. Please do everything he/she is due for. I understand this will be done at my expense.

I would like a nail trim/grind (please select preference)

Nail Trim $22.00

Nail Grind $36.00

I do not want a trim/grind

Heartworm Treatment

I need heartworm and/or flea prevention. I understand an annual heartworm test must be current in order to dispense prescription preventative. I understand when requesting preventative, if test is not current, it will be performed at my expense.

Please Select A Treatment (Heartworm/Flea prevention)

Heartgard (canines only)

Trifexis (canines only)

Sentinel Spectrum (canines only)

Activyl (canines/feline)

Comfortis (canine/feline)

Bravecto* (canines only)

Your Comments/Questions

CAPTCHA

Pet Drop Off Form – Bayside Animal Hospital

Drop Off Agreement Form

Extra Services

Please Select A Treatment (Heartworm/Flea prevention)