Patient Drop Off Form Patient Drop Off Form Patient Drop Off & Additional Services Form Patient Drop Off & Additional Services FormThank you for dropping your pet with us. The following information will be used by our veterinarians to accurately address your pet's medical needs for today's visit. Date Owner's Name First Last Pet's NamePhone Number (where you can be reached today)Reason for Visit (check all that apply)Annual VaccinationsWellness ExamDental EvaluationIllnessBehavioral ConsultationWeight ManagementBlood WorkRadiographsOtherAre there any concerns for: (Check all that apply)EatingBad BreathVomitingLimpingDrinkingItching/ScratchingDiarrheaMasses/GrowthsLethargyScootingUrination IssuesEyesWeight LossWeight GainShaking Head/EarsBehavioral ProblemsDifficulty RisingIs your pet currently on medications (please check one)yesnoHas your pet ever had an adverse reaction to vaccines or any medications? (please check one)yesnoDoes BHVG have your permission to provide any necessary treatment should an unexpected emergency occur? (please check one)yesnoWill you grant permission to sedate your pet if it becomes necessary?yesnoWould you prefer an estimate before any treatments/procedures are preformed? (please check one)yesnoPayment is due when pet is discharged.