Is your pet neutered/spayed *
Does your pet have a history of reactions to vaccines?
Does your pet have a history of reactions to medications?
Does your pet have a history of reactions to food?
What medications is pet on?
What heartworm is your pet taking ?
What flea medication is your pet taking?
Why does your pet need to be seen? Please describe the symptoms? How long? *
Describe your pets average day
Special notes about your pet *
BY SUBMITTING THIS FORM, I AGREE TO PAY IN FULL THE TOTAL CHARGES FOR SERVICES RENDERED AT THE TIME OF DISCHARGE. I ALSO AGREE TO PAY ANY FEES INCURRED FOR COLLECTION OF SAID CHARGE. I UNDERSTAND THAT FEES MAY VARY DEPENDING ON THE NATURE OF MY PETS CASE AND THE REQUIRED CARE AND TREATMENTS. AS A RESULT, ESTIMATED FEES MAY BE RAISED OR LOWERED. I UNDERSTAND THAT BEES FERRY VETERINARY HOSPITAL IS OFFERING A VARIETY OF TREATMENT OPTIONS, INCLUDING HOLISTIC AND ALTERNATIVE OPTIONS. BY AUTHORIZING ANY TREATMENT THROUGH CONSENT AND/OR PURCHASE, I RELEASE BEES FERRY VETERINARY HOSPITAL AND ITS AGENTS FROM ANY LIABILITIES. I UNDERSTAND THAT PICTURES AND VIDEOS OF MY PET MAY BE USED FOR BEES FERRY VETERINARY HOSPITAL RECORDS AND PUBLICITY BUT WILL NEVER BE SOLD, TRADED OR USED FOR OTHER REASONS. *