Drop-off for Illness - Concern | Westwood Veterinary Hospital

Your Pets Name: *

Your Name: *

Best phone number to reach you at today: *

If other, please explain:

Painful? If yes, where?

When did you first notice your pet's problem?

What medications/supplements does your pet currently take?

When did your pet eat last and what is his/her usual diet?

Is your pet taking monthly heartworm preventive?

Is your pet up-to-date on vaccinations?

Please list any vaccinations not administered at Westwood Veterinary Hospital and the dates they were given.

I authorize Westwood Veterinary Hospital to perform the following before notifying me:

Blood Work Profile: Checks hydration status, anemia, infection, clotting ability, and overall status of immune system. Also checks the kidneys, liver, and pancreas and gives blood sugar levels.Heartworm test: Canine- Checks for heartworms and three tick diseases: Ehrlichiosis, Lymes disease, and Anaplasmosis.Heartworm test: -Feline- Checks for heartworms, Feline Immunodeficiency Virus, and Feline LeukemiaIntestinal Parasite Exam: Fecal exam checking for parasites like Hookworms, Whipworms, Tapeworms, Roundworms, Flukes, Coccidia, and their eggs/larvae.Fluid Therapy: Sterile fluids given under the skin or intravenously to help with dehydration or to flush toxins.

Radiographs (X-rays)

I authorize a maximum expenditure of (fill in a dollar amount below) before the veterinarian/staff consults with me.

Promissory Note

I understand and agree that I am financially responsible for the payment of all services received and will be charged the interest of 1.5% of any outstanding balance over 30 days. If legal action is required to collect any fees due, I will be required to pay actual court cost and attorney fees.

Signature: *

Date *

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Drop-off for Illness – Concern

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Call us580-223-0203

Find us

Email us

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!Header Logo

!Call To Action

!Give us a call button

Drop-off for Illness – Concern

Call us
580-223-0203