Express Drop-Off Form First Name* Last Name* Street Address* Address Line 2 State / Province / Region* City* ZIP / Postal Code* Home Phone Work Phone Co-Owner First Name* Co-owner Last Name* Co-Owner Phone Email* How do you prefer to be contacted? Email Text Phone Other If Other, please specify: Pet's Name* Age Breed List other pets name/age/breed here Date of last heart worm preventative Name of product Date of last flea & tick preventative Name of product Date of last vaccines Name and Phone # of Vet Office Date of last laboratory testing Name of Vet How much time each day does your pet spend outside? What types of dental care to you do for your pet? Please list all food and treats your pet eats: Are you enrolled in our health savings plan? Yes No Do you have an insurance form for us to fill out? Yes No Drop off Date Drop off Time Select time 7:00 AM 7:15 AM 7:30 AM 7:45 AM 8:00 AM 8:15 AM 8:30 AM 8:45 AM 9:00 AM 9:15 AM 9:30 AM 9:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 1:00 PM 1:15 PM 1:30 PM 1:45 PM 2:00 PM 2:15 PM 2:30 PM 2:45 PM 3:00 PM 3:15 PM 3:30 PM 3:45 PM 4:00 PM 4:15 PM 4:30 PM 4:45 PM 5:00 PM 5:15 PM 5:30 PM 5:45 PM Preferred Pick up Date Preferred Pick up Time Select time 7:00 AM 7:15 AM 7:30 AM 7:45 AM 8:00 AM 8:15 AM 8:30 AM 8:45 AM 9:00 AM 9:15 AM 9:30 AM 9:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 1:00 PM 1:15 PM 1:30 PM 1:45 PM 2:00 PM 2:15 PM 2:30 PM 2:45 PM 3:00 PM 3:15 PM 3:30 PM 3:45 PM 4:00 PM 4:15 PM 4:30 PM 4:45 PM 5:00 PM 5:15 PM 5:30 PM 5:45 PM If your pet has been previously groomed, would you like the same hair cut? Yes No Would you like: Hair bow? Bandana? Nail color? Hair bow? Which number should Mallory, our groomer call to clarify scheduling and treatment? I need refills of: Sentinel (Heartworm prevention) Frontline Plus (Flea and tick control) Revolution (flea and heartworm prevention) Bravecto (3month chewable flea and tick preventative) Other Food Check box below that best applies I would like my pet to have all the health care that the doctor deems necessary which may include vaccines, laboratory testing, xrays, and other procedures and tests. I would like the doctor to call me before performing any tests or procedures (I understand that certain vaccines and tests are required for the safety of all pets staying in the hospital) I would like the doctor to call me if the bill is expected to go over $________ Please enable JavaScript for this form to work.