At Puyallup Valley Veterinary Clinic we are deeply committed to providing exceptional care for your beloved pets. While we take every precaution to ensure their safety and well-being, unforeseen circumstances can occasionally arise. Please read and acknowledge the following disclaimer, which is intended to protect both parties involved: DISCLAIMER: Puyallup Valley Veterinary Clinic and its staff will exercise the utmost care and professionalism when attending to your pet's needs. However, despite our best efforts, there is a minimal inherent risk associated with veterinary procedures, treatments, and the general handling of animals. By signing this drop off form, you acknowledge and accept that: 1. You understand and agree that veterinary procedures, treatments, and other interventions involve some level of risk. These risks include, but are not limited to, potential injury, reactions to medications, unforeseen complications, or anesthetic risks. We will make every effort to minimize these risks and keep you informed throughout the process. *

I agree and consent to the above.

2. You will provide us with accurate and up-to-date information regarding your pet's medical history, current medications, allergies, and any other relevant details. Failure to disclose such information may affect the outcome of the treatment and subsequent care. *

I agree and consent to the above.

3. In the event of an emergency or medical complication, we will make reasonable attempts to contact you using the contact information provided. However, we reserve the right to take immediate action if necessary to safeguard the health and well-being of your pet. You agree to assume any financial responsibility associated with emergency treatments, including additional procedures or hospitalization. *

I agree and consent to the above.

4. While we strive to provide a safe and secure environment, animals can exhibit unpredictable behavior, and interactions between animals may result in injury. We request that all pets are properly secured in carriers or on leashes to minimize the risk of harm. *

I agree and consent to the above.

By signing this drop off form, you release Puyallup Valley Veterinary Clinic, its veterinarians, and staff from any liability or claims arising from injuries, illnesses, complications, or unforeseen events that may occur during your pet's stay or treatment at our facility. You understand that you are responsible for any associated medical costs and agree to indemnify Puyallup Valley Veterinary Clinic against any claims or legal actions related to such incidents. Please feel free to ask any questions you may have before signing this form. We appreciate your trust and understanding as we work together to ensure the well-being of your cherished companion. *

I agree and consent to the above.

Client's Name *

First

Last

Phone *

Email *

Pet's Name *

Age/Date of Birth *

Breed *

Color

Approximate Weight *

Check-In Date *

Projected Check-Out Date *

We may need to contact you or someone you trust to make medical and financial decisions. Please provide us with the two contacts and the best phone numbers for each.

Additional Person's Name *

First

Last

Additional Person's Phone *

Secondary Person's Name

First

Last

Secondary Person's Phone

Reason For Visit (please check all that apply) *

Wellness exam/vaccines
Boarding
Imaging
Medical problem

Medical problem: please explain *

Has your pet shown any of the following signs? (please check all that apply) *

If other, please specify *

New growths - please describe *

Pain/lameness - please describe *

Urinary issues - please describe *

When did your pet last eat? *

What did your pet eat? *

Do you have any special feeding instructions for your pet?

Please list all the medications and the instructions for each

If your pet needs to be sedated, do we have permission to do so? *

Yes
No

If anesthesia is authorized above, please note that by signing this form you understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I am the owner (or authorized agent of the owner) of the animal described above and have the authority to execute this consent. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed.

If yes please understand that by signing this form you understand that some risk always exists with anesthesia, even in apparently healthy animals, including the possibility of death. I have discussed my concerns with the veterinarian. I realize that no guarantee, legal or ethical, can be made to me regarding the outcome of any procedure performed. I hereby authorize the use of anesthetics, as deemed necessary by the veterinarian. I understand that hospital personnel will be employed in treating my pet. I have carefully read and fully understand this consent. The fees associated with these services have been explained to me, and I agree to pay such fees in full at the time my pet is released from the hospital.

I understand that if my pet is found to have fleas, we have the right to treat at your expense. *

I have read and understand

Please list all leashes/carriers/blankets/toys/food that is being left with your pet

The fees associated with these services have been explained to me, and I agree to pay such fees IN FULL at the time my pet is released from the hospital. *

Clear Signature

Owner Signature

Date *

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Patient Drop-Off Form

Patient Drop-Off FOrm

Schedule an Appointment

360-373-1465

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