Drop Off Form | Williams-Sebby Vet Clinic & Pet Resort

Name*

Pet(s) Name(s)*

Email*

What type of animal will be staying with us?*

Canine
Feline

To the best of your knowledge, is your pet up to date on his/her shots?*

Rabies (Canine/Feline)
Bordetella (Canine)
DHLP-PV (Canine) *
HW Test (Canine)
Influenza Combo (Canine)
FVR-CP (Feline) *
FELV (Feline)
FIV-FELV test (Feline)

Reason for Visit?*

Duration of problem?*

What phone number(s) may we reach you at today?*

To help us better evaluate your pet in your absence, please answer the following:

Water intake is normal?*

Yes
No

Appetite is normal?*

Yes
No

Weight Loss?*

Yes
No

Coughing?*

Yes
No

Active?*

Yes
No

Listless/Lethargic?*

Yes
No

Diet Change?*

Yes
No

Is your pet on Heartworm preventative?*

Yes
No

Any vomiting?*

Yes
No

If yes, how often?

Any diarrhea?*

Yes
No

If yes, how often?

Acting like they are in any pain?*

Yes
No

If yes, how often?

Any bleeding?*

Yes
No

If yes, how often?

Any lameness?*

Yes
No

If yes, how often?

Often bloodwork and x-rays are needed to diagnose what a routine visual exam does not.

**These have additional charges**

X-rays*

Approved
Declined

Bloodwork*

Approved
Declined

Tranquilization*

Approved
Declined

Drop Off Requirements

1. All animals must be current on all required vaccinations.
2. All animals must be free of external and internal parasites (ticks, fleas, etc.), or they will be treated at the owner’s expense.
3. WSVC has my permission to do whatever necessary should an emergency arise.
4. Pets may be picked up between 2:00 pm – 5:45 pm, Monday – Friday. No Exceptions!
5. Any towels or personal items should be marked with the last name. This will ensure that if they become soiled, we are able to identify them after washing. (When items become soiled, it is unsanitary for us to keep without washing them.)

Signature required at time of drop off*

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