Online Forms

Drop Off Consent Form

Name: Puyallup Valley Veterinary Clinic
Address: 2208 E Main Ave, Puyallup, WA, 98372, United States
Telephone: 253-845-8122
Price range: $

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Drop Off Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 253-845-8122 for a faster response.

Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Patient Name *

Species *

Breed *

Age *

Multiple Choice

Male
Female
Neutered Male
Spayed Female

When did your pet last eat? *

What did it eat? *

What is your pets regular diet? *

Is your pet on any medications? If so, what are they? *

Please describe in further detail any symptoms marked above as well as any other symptoms present: *

Can we get rid of this and change it to: 'If your pet needs sedation do we have your permission to do so? *

If anesthesia is authorized above, please note that by signing this form you understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I am the owner (or authorized agent of the owner) of the animal described above and have the authority to execute this consent. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed.

The fees associated with these services have been explained to me, and I agree to pay such fees IN FULL at the time my pet is released from the hospital. If your pet is found to have fleas, we have the right to treat it at your expense. Initial here. *

Signature *

Clear Signature

Date *

Best Phone *

Alternate Phone *

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Drop Off Consent Form

Drop Off Consent Form

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