1186 - Mechanicsville Animal Hospital

Owner Information
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Alternate Contact
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Pet Information
Pet's Name*
Can you make medical and financial decisions regarding this pet?*

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Name

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Relation to you:
Reason for visit*

Preventative CareExamIllnessInjuryBloodworkRecheckGlucose CurvePost-Op SurgeryOther
Explain your pet's visit today:*
Additional Concerns*

I have no other concernsEating LessDrinking LessDrinking a lotExcessive SleepingDiarrheaBehavioralUrination IssuesSkin Masses / LesionsVomitingWeight LossWeight GainItching / ScratchingShaking HeadCar SicknessBad Breath
Duration of these symptoms?
Has your pet ever had an adverse reaction to any:
Vaccines:*

YesNo
Medications:*

YesNo
Procedures:*

YesNo
If so, please describe:
Your pet's last meal:*

AM todayPM yesterdayAM yesterdayOther
Pet's Diet:*
I hereby authorize the veterinarian and Mechanicsville Animal Hospital to examine, prescribe for, or treat the above described pet. I will assume responsibility for all charges incurred for the care of this animal. I also understand that these charges will be paid at completion of service or time of release and that a deposit of 50% is required for surgical and/or in-hospital treatments. As the owner/authorized agent for the above patient. I give consent for Mechanicsville Animal and maintain anesthesia if deemed necessary. I understand and accept that there is a risk associated with any type of anesthetic procedure.*

I authorize.
Additional Services for Your Pet's Care

Additional charges will apply
Kennel Bath:

Do you have family coming into town or does your pet smell especially “doggy” lately? Although this is not a professional grooming service, we can give your pet a quick bath to help them smell their best.

Nail Trim:

Are you noticing that your pet’s nails are getting too long when they jump on you or up on a favorite resting spot, or when their excessively long nails are scratching the floor? Long nails can cut skin and rip furniture. They can cause pain and injury to your pet as well. While they are receiving care from us today we would be happy to trim your pet’s nails for you! An additional charge also applies If sedation is required.

Anal Gland Expression:

The famous scoot across the floor is a good indication that your dog needs their anal glands expressed. Other signs are a fishy odor around your dogs behind or licking near their rectum. This may be an indication that your pet needs their anal glands expressed.

Microchip:

Microchips are an important part of pet ownership. In the event your pet becomes separated from you, any shelter or veterinary facility has the ability to scan for microchip information. We recommend that all pets be microchipped. This service is something that we can do at your pets drop off today.
Please indicate if your pet needs the following:*

Kennel BathNail TrimAnal Gland ExpressionMicrochipNone
Refill medications: Please list the medication(s) you will need for us to refill:
Refill Heartworm Prevention

Interceptor PlusHeartgard Plus
Refill Flea and Tick Prevention

NexgardBravectoRevolution +
Payment is expected at the time services are rendered. We accept cash, personal checks and all major credit cards. We will gladly prepare a written estimate if you desire. We make every effort to make sure all fees are fair and reasonable and you are encouraged to discuss charges before services are rendered.
Printed Name for E-Signature*

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Owner Information

Pet Information

Additional Services for Your Pet's Care