Please list your full name.
What day is your scheduled appointment?
Please list your current mailing address so we may verify our records.
Please list your current email address so we may verify our records.
What is the best phone number to reach you today?
If you are dropping off more than one pet, please compete a separate form for each pet.
A primary owner is the main contact, makes medical decisions, and is financially responsible for this pet.
Please list the primary owner for this pet.
Please list all contact numbers for the primary owner of this pet.
Please list a secondary owner if there is one for this pet. A secondary owner can authorize medical treatments and make financial decisions on your behalf. The primary owner is responsible for any financial decisions made by the secondary owner.
Please list all contact numbers for the secondary owner of this pet, if applicable.
Which contact method do you prefer for an update on when your pet is ready to go?
Please list the reason for your pet's visit today.
Please select the services you would like your pet to have during this appointment.
Please list your pet's brand of food and if you feed dry/wet/combination of both.
Please select what best describes the normal amount of food fed to your pet and how often they are fed.
Please select all that represents your pet's normal environmental exposure.
What medications are your currently giving your pet?
Please list the brand(s) of the medication(s) you are giving your pet.
Do you need any refills on your pet's medications?
Please list what medication(s) you need to be refilled and the quantity.
When performing the physical exam, the veterinarian may order tests to better diagnose your pet's medical issues. Please check any tests that you agree to be performed without a phone call for an authorization.
Our veterinarians can be requested. If they are working and available on your appointment date, you may list a request.
By checking this box, I authorize the veterinarians and staff at Best Friends Animal Hospital to perform the elected procedures. I accept that all procedures will be performed to the best of the ability of all employees at this hospital and I understand that no guarantee or warranty has been made regarding the results that may be achieved. I have read and fully understand the terms and conditions.
In case of an emergency, please choose from the following options how you would like for us to proceed with CPR. The veterinarian and staff will make every effort to contact you as soon as possible.
If you have any financial concerns about payment for your pet's medical treatments or medications, please let a receptionist know before leaving your pet. We offer Care Credit and iCare. We do not offer in-house financing.
By checking this box, I agree that I am the primary owner of this animal and I am financially responsible for all charges on this pet's account, or I have authorization from the primary owner to take these responsibilities. I understand that payment is due when I pick up my pet.