Monday-Friday 7 AM to 7 PM
Saturday 9 AM to 4 PM

Drop Off Consent Form

Date*
MM slash DD slash YYYY
Patient Name*
Client Name*
First Last
Preferred Doctor
Reason for Visit*
If here for a problem, when was the issue first noticed?
As of today, is the issue better, worse, or no change?
- Better
- Worse
- No Change
Current Diet
Current Medications
Additional Notes
Drop Off Consent*
- I understand that a veterinary technician of Kingsland Blvd Animal Clinic (KBAC) will contact me via the provided phone number to further discuss any diagnostic tests & treatments deemed necessary by the attending veterinarian. While I accept that all procedures will be performed to the best of the abilities of the staff at this hospital, I understand that no guarantee or warranty has been made regarding the results that may be achieved. I also assume full responsibility for any additional expenses incurred after the procedure is performed, such as follow-up radiographs, re-check physical exams.
Primary Contact Information*
First Last
Phone Number*
Secondary Contact Information (if primary can't be reached)*
First Last
Phone Number*
Phone
This field is for validation purposes and should be left unchanged.