Drop Off Form 3 Fill out the form below and we will reply as soon as possible. Be as detailed as possible to ensure swift and accurate service. If you’re in need of immediate assistance, please contact us directly at (573) 334-6283. Pet's Name *Owner's Name *FirstLastContact Phone *Email *Preferred Doctor *Dr. ByrdDr. FoutzDr. LeGrandDr. CurryNo PreferenceRequest for illness related care - Please select all that apply to your pet's current conditions.Appetite changesBleeding gumsBlood in stoolBreathing problemsCoughingCheck lump/bumpDiarrheaDifficulty breathingDrinking habit changesEar problemsEye problemsHair lossItchyIngested foreign objectLameness/limpingLoss of balancePainfulScootingSneezingShaking headUrination changesAccidentsVomitingWeaknessWeight lossWoundsIncreased or decreased? How long?How long?How long? Where?How long? How long? Increased or decreased? How long? Left or right?Left or right? How long? Please describe which limb / whereWhere?Increased or decreased? How long and what?Where?Any other concerns not listed?List all medications currently taking:Heartworm prevention? If yes, what kind:Flea/Tick control? If yes, what kind?What does your pet eat?If deemed medically necessary by the doctor, I authorize the following care for my pet:Diagnostic Blood work $45-$150 *YesNoUrinalysis and Sedimentation $35 -$45 *YesNo Radiographs (X-rays) $130 *YesNoHeartworm test $34 *YesNoIntestinal Parasite test $15 *YesNoFeline Leukemia/FIV test $37 *YesNoPlease read and check ONE of the following: *I authorize the testing and treatment deemed necessary by the veterinarian.Please call me before performing any diagnostic tests or procedures with an estimate.Digital Signature *Date *EmailSubmit
