Pet Drop-off Form If your pet will be dropped-off for an appointment or boarding, we ask you please complete the following: Drop-off Information Drop-off Information Pet's Name * Owner Full Name * Phone Number * Best number to reach you with questions and visit follow-up information Person Dropping-Off and/or Picking-Up Your Pet If different from Owner Reason for Exam or Visit Please explain the reason for the visit and describe any concerns you may have for your pet. Pet's Symptoms, if any Coughing Sneezing Vomiting Diarrhea Low Energy, Activity Loss of Appetite Limited Water Consumption Check any symptoms that apply to your pet. Brand and Type of Pet Food: * Please provide the brand and type of food you are providing to your pet Feeding Frequency and Quantity * How much and how often do you feed your pet? Example 1 Cup, 2 times per day Is your pet given heartworm medicine regularly? * Yes No Brand of Heartworm Medicine: * Is your pet given Flea and Tick prevention medicine regularly? * Yes No Brand of Flea and Tick Medicine: * Other Current Medications * Describe all medications, dose, and frequency of use for all medications your pet is given, including over-the-counter medicines and flea/tick or heartworm medicines. Use N/A or none as appropriate.