Advanced Veterinary Care

1500 125th Ave NE
Blaine , MN 55449

(763)310-3500

www.avetcare.com

Drop-Off Form

Drop-Off Form

Client's Name (required)
First Name (required)
Last Name (required)
Client's Phone Number (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Pet's Name & Species (required)

What will we be seeing your pet for today? (Please be very detailed) (required)

What has been the duration of this illness/injury?

Any new foods/treats added to the pet's diet recently? (required)

Has your pet had an increase or decrease in any of the of the following: (Please choose one for each)
Drinking (required)

Increased
Decreased
No Change


Appetite (required)

Increased
Decreased
No Change


Urination (required)

Increased
Decreased
No Change


Defecation (required)

Increased
Decreased
No Change


Weight (required)

Increased
Decreased
No Change


Was your pet fed today? (required)

Yes
No


Amount of food fed at each meal:

What is your pet’s diet?

Is your pet current on vaccinations? (required)

Any previous illness/surgery not address at AVC?

Is your pet on any medications/flea control/Heartworm preventions/supplements? (list)

Do we need to obtain records from another vet clinic? (If yes, Where)

Do you give consent for us to call for records on your behalf?

Yes
No


If your pet has any unusual; lumps, bumps, wounds or skin irritation which you would like the doctor to address today, please list their locations and a brief description

Please read and initial ONE of the following:
I authorize testing and treatment per estimate given and place no limit on additional charges/services deemed necessary by the veterinarian.

I authorize testing and treatment per estimate given and approve charges up to an additional $

Please call me with an estimate before performing any procedures not outlined on the estimate given. If I cannot be reached, I authorize additional treatments deemed necessary by the veterinarian


Please call me with a revised estimate before performing any additional procedures not outlined on the estimate given. I understand that if I cannot be reached, my pet will receive NO treatments, except in the case of an emergency, other than those outlined on the original estimate


What is the best phone # for today (required)
Phone TypePhone Number (required)
What time would you like to pick up? (required)


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