Drop Off Form

First Name(Required)

Last Name(Required)

Cat's Name(Required)

Best Phone # To Reach You(Required)

What is the cat being dropped off for?(Required)

Is the cat on any medications? If yes, what medications and dosage?(Required)

What are the cat's feeding instructions?(Required)

Are there any concerns for the Doctor today?(Required)

Please give us a brief medical history of your cat.(Required)

I authorize my pet to be examined for services today. I understand that no outcome or cure is guaranteed following today’s exam. I agree that I will not hold The Feline Hospital or its associates responsible for the patient’s outcome or recovery. I agree to pay in full for services rendered today. I have been advised to the approximate cost of services today and I also have the right to ask for the approximate cost, if it was not provided. The Feline Hospital has the ability to perform CPR in the event of an unforeseen complication or emergency. There may be additional costs to perform CPR if it is needed, and there is risk of injury associated with the acts required in performing cardiopulmonary resuscitation. I understand that the approximate percentage of my pet making a full recovery after suffering a cardiopulmonary arrest are less than 10%. By approving CPR, I understand that there is no guarantee of a positive outcome for my pet and I agree not to hold The Feline Hospital responsible for any outcome. By signing below, I agree to the above statement.

Please choose one(Required)

I would like to have CPR performed on my pet in the event of an emergency.

I would not like for CPR to be performed on my pet in the event of an emergency.

Signature(Required)

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Drop Off Form

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