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Your Name
Pet's name
Phone
Email
Would you like us to call or text you with questions or when your pet is ready to go home?
Call
Text
Alternate contact person
Alternate phone number
Requested pick-up time (no earlier than 2 pm)
Is your pet current on vaccinations (including Kennel Cough/Bordetella)?
Yes,
done
at
MAH
Yes,
done
at
another
vet
clinic
No
If vaccinations were performed elsewhere, please specify and list the phone number.
Have you taken your pet to another grooming/boarding/pet daycare facility in the last 3 weeks?
Yes
No
Please explain if you chose yes.
Have you or your pet been exposed to or tested positive for COVID-19 in the last 2 weeks?
Yes
No
Please explain if you chose yes.
Please check if your pet has any of the following:
Coughing
Sneezing
Eye problems
Ear problems
Skin problems/itchy
Growths/lumps/bumps
Vomiting
Diarrhea
Lethargy
Loss of appetite
Other
If other, please specify.
Please explain your pet's symptoms. How long have you noted them. For coughing, sneezing, and vomiting, how many times per day. Include areas of concern on skin/body, if applicable.
If there are other things you would like for the doctor to examine/address, please note them here.
Please list your pet's heartworm, flea, and tick preventative(s) with date last given or applied.
What diet do you feed your pet? How much and how many times per day?
List any medications, supplements, and topical treatments that your pet receives on a regular basis with amount and how often you give/apply them.
Authorizations
Authorizations
I understand that even though precautions are taken to prevent contagious upper respiratory tract infections (e.g. Kennel Cough), that the possibility of exposure does exist and I will not hold McKinney Animal Hospital liable. I also understand that at times some animals may experience vomiting and diarrhea during boarding or hospitalization (usually due to stress and/or diet change) and I give McKinney Animal Hospital consent to treat as needed.
I understand.
I understand that if I cannot be contacted, McKinney Animal Hospital will treat my animal as deemed appropriate by the doctor in charge should an illness or previous medical condition arise. I accept responsibility for charges incurred during treatment.
I understand.
I understand that all animals will be checked for fleas & ticks upon arrival and treated if necessary.
I understand.
I have read and accept the above stated terms.
I accept.
Today's Date
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