Online Forms

MORELAND ANIMAL HOSPITAL
Drop Off and Sedation Consent Form

Save time during your upcoming appointment by filling out the required paperwork online on any computer or device.

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Client and Pet Information

Owner Name: *

Date: *

Pet Name: *

Best Phone Number Today: *

Breed *

Sex: *

2nd Phone Number:

Preferred Contact Today *

Call
Text
Voicemail ok

Today's Main Concern: *

Are All Vaccines Current? *

Yes
No
Update Today (Required vaccines, Canine: Rabies, DHPP (DHLPP), and Bordetella; Feline: Rabies, FVRCP. If vaccine history cannot be verified, required vaccines may be updated before treatment when possible. Capstar may be given if needed.)

Quick Health Questions

Eating and Drinking Normally? *

Urinating Normally? *

Defecating Normally? *

Any Vomiting, Diarrhea, Coughing, or Behavior Changes? *

Current Medications? *

Medication Given Today? *

Heartworm Prevention? *

Flea/Tick Prevention? *

Tell Us What is Going on

When did this concern start? Please be as exact as possible. *

Today's Services and Sedation

Do we have permission to sedate if needed? *

If needed for: *

X ray
Bloodwork
Nail Trim
Other

Do we have an accurate DNR/CPR form on file? *

HomeAgain microchip placement: *

Accept
Decline

Canine Prevention Options: *

Sentinel 6 month
Sentinel 12 month
Bravecto 3 month
Bravecto 6 month

Main for: Medications?

Other services or notes requested today: *

Authorization and Payment

Authorization and Payment *

I certify that I am the owner or authorized agent of the pet listed above and am at least 18 years old. I authorize Moreland Animal Hospital, its veterinarians, and team members under veterinary supervision to examine, treat, and perform the services selected above. If sedation is used, I understand it is intended to be light conscious sedation, but risks can occur with sedation, treatment, and procedures. I understand that medical needs may change during care and that the doctor may recommend changes when needed. Payment is due at the time of service or discharge. We accept cash, debit/credit cards, and CareCredit.

Owner/Agent Signature: *

Clear Signature

Date *

*This promotion is valid for new clients only and may be used once per client. Cannot be combined with other offers or promotions. Other restrictions may apply.

Online Forms

MORELAND ANIMAL HOSPITAL
Drop Off and Sedation Consent Form

Client and Pet Information

Quick Health Questions

Tell Us What is Going on

Today's Services and Sedation

Authorization and Payment

Book Appointment

Location

Contact

Hours of Operation

Have a Question?

We Proudly Serve the Pets of Moreland, GA, and the Surrounding Areas:

Online Forms

MORELAND ANIMAL HOSPITAL Drop Off and Sedation Consent Form

Client and Pet Information

Quick Health Questions

Tell Us What is Going on

Today's Services and Sedation

Authorization and Payment

MORELAND ANIMAL HOSPITAL
Drop Off and Sedation Consent Form