"*" indicates required fields Date* MM slash DD slash YYYY Name* First Last Pet Name* Age* Breed* Color* Sex* Male Intact Female Intact Male Neutered Female Spayed Weight* Reason for today's visit*Phone Number to best reach you*Do you have our phone app ?* Yes No If no, please download as moving forward we are going to do our best to ensure we are communicating through the app. If yes, please ensure your notifications are on to ensure you are receiving our updates throughout the day.At what time are you available to pick up your pet today?* Hours : Minutes AM PM AM/PM Frequency and dosages of all medications pet has taken:*Please select any other treatments you would like your pet to receive: Microchip $82.03 Nail Trim Vaccines Fecal Bloodwork Anal Glands Flea Medication Prescription Refill Vaccines* In order to allow for diagnostics/treatments to be started, we require a minimum allowance when a patient is being dropped off: $215 for wellness/vaccine visits, diarrhea cases itching cases and/or ear infection $265 for inappropriate urinating and/or suspect urinary tract infections $415 for patients who are vomiting, limping and/or inappetent (xrays are expected) xrays alone are $250+exam = $330. If in the unlikely event that life saving measures need to be taken while my pet is under the care of HPVC:* I DO want any/all measures performed to save my pet. I do NOT want heroic measures taken to save my pet Heroic measures may include oxygen treatment, iv fluids, additional medications, and CPR. Additional fees of at least $150 will be charged if this is necessary. Please call AFTER 3pm to check on the status of your pet. We close at 4:30pm on weekdays. We are closed on the weekend. If your pet has been ready to go and they're not picked up by 4:45pm, an additional charge of $25 will be applied for the late pickup fee. We are in a residential area and cannot board pets overnight, please make arrangements for your pet to be picked up before closing. There is no staff on premise overnight. Fees/Payment-It is understood that I shall be responsible for the costs in connection with any care and/or medical treatment related to the above issue and that payment shall be made in full, prior to the return of my pet to my care. I understand that any estimate of fees given for a treatment plan are just that, an estimate, and that the cost to treat my pet may exceed expected treatment plans. Checked in by* First Last Date* MM slash DD slash YYYY Time* Hours : Minutes AM PM AM/PM Signature*
