Drop-Off Form

To help us provide the best care for your pet while they are with us, please complete the drop-off form below. This gives our team important details about your pet’s condition, medical history, and your expectations for today’s visit.

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Save Time During Drop-Off

This form collects essential information about your pet when you leave them in our care. It covers health concerns, current medications, emergency contact details, and treatment estimates. Completing it ensures your pet’s visit is safe, efficient, and tailored to their needs.

Drop-Off Form

Owner Information

Full Name *

First

Last

Phone Number *

(Primary contact during visit)

Secondary Phone Number

(Optional)

Email Address *

Pet Information

Pet's Name *

Species *

Dog
Cat

Breed *

Age / Date of Birth *

Color / Markings *

Reason for Visit

What is the main concern or reason for today’s drop-off?

How long has this issue been present?

Any additional symptoms or behavioral changes?

Medical History

Current medications or supplements:

Known allergies or previous adverse reactions:

Pre-existing medical conditions:

Feeding & Care Instructions

Has your pet eaten today?

Yes
No

When was the last meal given?

Any special care instructions during their stay?

Estimated Treatment Costs

I acknowledge that I have received an estimate for today’s visit and understand that costs may vary depending on findings and treatment needs. *

I agree.

Maximum amount authorized for treatment without additional approval: $_____

Emergency Directive (CPR/DNR)

In case of cardiac or respiratory arrest, do you request resuscitation efforts (CPR)?

Yes
No

(Additional charges may apply for CPR attempts.)

Owner Consent & Signature

I, the undersigned, authorize Shoreline Veterinary Hospital to examine, treat, and care for my pet as outlined above.

Signature

Clear Signature

Email

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Drop-Off Form

Save Time During Drop-Off

Drop-Off Form

Owner Information

Pet Information

Reason for Visit

Medical History

Feeding & Care Instructions

Estimated Treatment Costs

Emergency Directive (CPR/DNR)

Owner Consent & Signature

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