Drop-Off Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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a cat sitting on the floor next to a litter box

Online Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Phone *

Pet's Name *

Drop-Off Information

Reason for drop-off *

Duration and symptoms *

Have you noticed any of the following:

Changes in appetite or thirst *

Changes in weight *

Coughing/Sneezing *

Changes in energy level *

Vomiting/Diarrhea *

Exercise/Intolerance *

Has your pet ever experienced any of the following:

Anesthetic Complications *

Drug/Vaccine Reactions *

Serious Illness/Injury/Disease *

If you answered yes to any above, please elaborate:

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

When was the last time the patient had any food? *

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 *

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 Veterinary Group. We do accept CareCredit. By signing below, I agree to all the statements above and agree that all the information I supplied on the document is true.

Print Name *

Date *

Drop-Off Form

Online Form

Drop-Off Information

Have you noticed any of the following:

Has your pet ever experienced any of the following:

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

Make a Veterinary Appointment

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