New Boarding Form | The Garden Vet | Carroll Gardens Veterinarian

Drop Off Consent Form

CLIENT INFORMATION

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Drop-Off Consent Form


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Have you noticed any:

Changes in Appetite or ThirstChanges in WeightCoughing/SneezingChanges in Energy LevelVomiting/DiarrheaExercise Intolerance

If so, please elaborate:

Has your Pet ever experienced any of the following:

Anesthetic ComplicationDrug/Vaccine ReactionsSerious Illness/Injury/Disease

If so, please elaborate:

What is the current diet/how much are you feeding*:

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When was the last time the patient has any food*:

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List any and all medications (prescriptions and over the counter):

Once the doctor has examined your pet: (check which applies)

Do not proceed with any diagnostic or treatment recommendations without speaking with the emergency contact
Proceed with diagnostic and treatment recommendations at the doctor's discretion not to exceed:
Proceed with diagnostic and treatment recommendations at the doctor's discretion

In the unlikely case of a life threatening emergency:

I consent to extreme measures including but not limited to CPR, and drug treatments to be taken to prevent death (min. $300-$500)
I do not consent to extreme measures to be taken to prevent death; do NOT resuscitate

I understand payment is due at time services are rendered and no payment plans are offered at Carroll Gardens Vet Group. We do accept Care Credit. By signing below, I agree to all the statements above and agree that all the information I supplied on the document is true.


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