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Home
Services
General Health
Diagnostics
Surgeries
Boarding and Grooming
Horse Veterinary Care
Drop Off Examination
Pharmacy
Televet
About
Doctors
Events
Staff
Testimonials
Contact
Drop Off Examination
Customarily, appointments with our doctors are set at a specific time of day. If you are unable to stay for an appointment, however, we are happy to offer the option of a drop-off exam. Because you will not be present to answer our doctor’s questions, you will be asked to fill out a drop-off examination authorization and release. To save time, you may use the following submission form to answer these questions electronically before bringing your pet in. Remember to get in touch with our Receptionist via phone or email before bringing your pet in even if you will not be present for their exam.
Drop-Off Examination
Authorization and Release
Pet's Name
*
Owner's Name
*
First
Last
Today's Date
*
MM slash DD slash YYYY
Phone Number where you can be reached today:
*
What are we seeing your pet for today?
*
Please indicate which of the following apply to your pet (explain as needed):
Current medications your pet is on & what dosage and time medications are given:
*
Changes in Appetite
*
Decrease
Increase
Vomiting
Diarhhea
No changes
Have there been any recent diet changes?
*
Lifestyle of Your Pet
*
An available veterinarian will perform a full physical examination on your pet as soon as the schedule allows. Although we will make every effort to contact you prior to treatment, it is very important to start diagnostic procedures and treatment as soon as possible. This may include, but is not limited to blood work, radiographs,fluid therapy, and medications.
What level of immediate diagnostics and treatment do you authorize?
*
Level 1 $300 - $450 (exam, blood work, radiographs, fluids, medications)
Level 2 $150 - $300 (exam, blood work, fluids, medications)
Level 3 $90 - $140 (exam, fluids, medications)
Level 4 $58 (exam only, I must be reached before starting any diagnostics or treatment)
Authorization
*
I understand that all drop-off patients will also be charged a daycare or hospitalization fee ranging from $15-45. As the owner/responsible agent of this pet, I authorize Millwood Animal Hospital to provide the necessary medical procedures listed above. I agree to assume all financial responsibility for any charges incurred and understand that such charges are due in full at the end of my pet's hospital stay.
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Email
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