Drop Off Form Date *a late fee will be applied to any pets picked up after closingClient *Phone Number *Email *Patient *As Fear Free Certified Professionals we use peanut butter and other foods to help make your pet at ease. Please indicate if you, or anyone in contact with your pet has a peanut or other food allergy. * *I have, or someone in contact with my pet has a food/peanut allergy.There is no one with a food/peanut allergy in contact with my pet.When did your pet last eat? *will verify at time of drop off in case of changeHas your pet had an adverse reaction to any medications, vaccines, or other procedures? *Is your pet taking any medications? *will verify at time of drop off in case of changeI understand that if needed, you will give complimentary anti-anxiety or other calming medications or supplements to help make my pets stay with us more enjoyable and less frightening. *please let us know at drop off if your pet has been sensitive to any medications in the pastPlease check any additional services requested below:Pedicure $15*Express Anal Glands $26Ear Cleaning $23Ear Hair Removal $14Brush and Clip Mats $15 minimumBath $20 minimum (If weather/time permits)Flea PreventionHeartworm Prevention (if valid heartworm test)*pedicures are complimentary with all sedation and anesthetic proceduresI understand that if needed, all pets with live fleas will be administered a product to kill the fleas. (Capstar) This will eliminate the fleas from your pet and protect our hospital from becoming infested and spreading to other pets. If given, a charge will appear on my invoice. *In the unfortunate event that your pet should need CPR or lifesaving measures do you: *Request nothing to be doneRequest CPR and nothing more (Minimal additional cost of $150)Request all possible lifesaving measures to be performed (Minimal additional cost $400)I, to the best of my knowledge, have filled out this form and believe it to be accurate and true. *NameSubmit
