(847) 835-1302
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 (847) 835-1302
We're currently closed

Drop Off Release Form

Name:

Email:

Symptoms Yes/No DURATION FREQUENCY
Vomiting
Diarrhea
Coughing
Sneezing
Eye Discharge
Nasal Discharge
Blood Urine
Blood in stool
Straining to Defecate
Urinating Frequently
Increased Thirst
Itchy
Weight Loss
Lethargy
Lameness(Limping)
  • What is your pet's diet
  • Recent changes to diet?
  • Current medication?

Please describe in detail why your pet is here today:

  • Contact number where you can be reached to authorize treatments:
  • In the event that you cannot be reached, do you authorized us to proceed with treatments in the best interest of your pet at the doctor's discreation
  • YesNo

By checking this box, I am indicating that I have read and agree with all of the items above.

Yes, I accept the agreement