Drop Off Consent Form

"*" indicates required fields

Drop Off Consent

First Name*

Last Name*

Date*

MM slash DD slash YYYY

Phone*

Pet's Name*

DOB / Age*

Sex*

Male

Female

Species*

Cat

Dog

Breed*

Reason for visit*

Are you the pet's primary caregiver?*

Yes

I understand that current Wellness Exams, Distemper, and Rabies vaccines are required for all pets, as well as Parvo, Bordetella (6 months), and a Fecal Flotation for dogs before admission to the facility. Flu Vaccine (H3N2) is recommended for all dogs. Pet’s not current on vaccines/testing will be updated as long as it is deemed safe and advisable by a veterinarian. I know that I am responsible for associated costs.

I certify that to the best of my knowledge my pet is free of all external parasites upon signing this release. If parasites, such as fleas or ticks, are found, I understand that my animal will be treated on admission for an additional cost.

Would you like your pet to receive any additional services while with us today?

Nail Trim ($25.95)

Ear Cleaning ($32.50)

Anal Gland Expression ($33)

Conditioner ($12 in addition to a bath)

Medication Refills – are there any medications that you would like to pick up when you return for your pet?

Name of Medication

# of pills

# of bottles

Name of Medication

# of pills

# of bottles

Name of Medication

# of pills

# of bottles

Pick-Up

If your pet is being bathed he/she will be ready for pick up after 4:00pm.
Falconbridge closes at 6:00pm – please plan sufficient time for rush hour traffic to allow you to arrive prior to that time.

Is it ok to give your pet treats while it is here?*

Yes

Consent

Falconbridge can use my pet’s photos on social media

Falconbridge can use my pet’s photos on FalconbridgeAnimal.com and their social media pages. (Like us on Facebook & follow us on Instagram)

Phone number to reach you today*

Signature of Owner or Agent*

Date*

MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.