(859) 263-5037
office@richmondroadvetclinic.com
Careers
Contact Us
GIVING BACK
Doctors
Services
Pet Health & Wellness
Specialty Pet Care
Critical Pet Care
Boarding Services
Grooming Services
Adoption Sponsor
Schedule
Pharmacy
Blog
Videos
Pet Education
Anesthesia: When Necessary
Dental Procedures
Diagnostic Exams: Why Needed
Heartworm Medication: Why Exams Needed
Kitten Preventative Care
Puppy Preventative Care
Why Spay or Neuter
Existing Client Boarding
✕
Patient Drop-Off Form
Home
Patient Drop-Off Form
Patient Drop-Off Form
To help us provide the best care, please complete the following
Date
MM slash DD slash YYYY
Client Name
Phone Number
*
Patient Name
Emergency Phone Number
Why are you presenting your pet(s) for an exam today? Please include symptoms and duration.
Since you first noticed the symptoms, is your pet
Since you first noticed the symptoms, is your pet
Better
Worse
Same
Is your pet currently on medications?
Is your pet currently on medications?
Yes
No
When is the last time your pet was given medications?
Is your pet currently taking preventative for ticks/fleas?
Is your pet currently taking preventative for ticks/fleas?
Yes
No
Is your pet currently taking preventative for heartworm?
Is your pet currently taking preventative for heartworm?
Yes
No
Do you Keep your pet(s)
Do you keep your pet(s)
Indoor
Outdoor
What type of food do you currently feed your pet?
When is the last time your pet has eaten?
Has your pet lost or gained weight recently?
Has your pet lost or gained weight recently?
No
Yes
How Much / What Period
Has your pet's water intake changed?
Has your pet's water intake changed?
No
Yes
How Much / What Period
Has your pet's excretory habits changed?
Has your pet's excretory habits changed?
No
Yes
How Much / What Period
Treatment Authorization
I hereby authorize Richmons Road Veterinary Clinic (RRVC) to perform medical and initial diagnostics/surgical procedures on this animal as required for diagnosis and treatment. Please be advised RRVC is not responsible for any personal belongings left with your pet. All pets must be free of fleas. If any are seen, the pet will be safely treated at the owner's expense. In the event of a medical emergency, our veterinarians will provide necessary and resonable medical care. Please provide emergency contact information above so that we may reach you in such an event.
Your pet will be seen on a priority basis. This will be based on the nature of the problem and the time your pet was dropped-off. If you are unable to pick your pet up by clinic closing time, you may be charged an additional boarding fee.
Financial Policy
Payment is due as services are rendered; the balance is due upon discharge from the clinic. Payments can be made by cash, personal check (with proper identification), Visa, Mastercard, Discover, American Express or Care Credit.
Comments
This field is for validation purposes and should be left unchanged.
Existing Client Boarding
Careers
Contact Us
