Form: Technician Appointment ONLY

Curb-side Appointment Acknowledgement: Please CHECK ALL.

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I acknowledge that appointments taking place prior to April 4, 2022 will be a curb-side appointment, whereas appointments taking place as of April 4, 2022 will not. For curbside appointments, clients are not allowed inside, with the exception of one client, for special circumstances, such as end of life appointments. As of April 4, 2022, only ONE person can accompany their pet(s) for their appointment(s).

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I acknowledge that in order to enter the clinic (after April 4, 2022), I will be required to wear a mask, and must continue to wear the mask for my entire time in the clinic. Curbside service is still available to those who are unable to wear a mask.

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I confirm that I will not enter the clinic if I am experiencing ANY symptoms of illness, particularly those COVID-like in nature. This includes, but not limited to: new or worsening cough; shortness of breath or difficulty breathing; fever or chills; fatigue or weakness; muscle or body aches; new loss of smell or taste; headache; sore throat; congestion or runny nose; gastrointestinal symptoms (nausea, abdominal pain, diarrhea, vomiting); generally feeling unwell. I will also not enter the clinic if I have travelled outside of Canada within the last 14 days.

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I acknowledge that the payment options include: credit card (Visa, Mastercard, AMEX) or debit. Please note: our credit card/debit terminals DO NOT accept the tap function!

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I acknowledge that E-transfers are NO LONGER accepted as payment for appointments or same-day food/medication purchases (e-transfer can be utilized if pre-paying for food/medication). E-transfer must be received before any food/medication is ordered.

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I acknowledge that the appointments are approximately 30 minutes in length and I am expected to wait nearby for the duration of the appointment, unless advised otherwise by a team member.

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I acknowledge that I must meet a staff member AT THE DOOR for both drop-off and pick-up of my pet. Staff will not come out to grab animals from cars.

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I acknowledge that my appointment will be rescheduled if I am more than 10 minutes late or if this consent form is not filled out prior to the appointment.

Date of the Appointment: (mm/dd/yyyy)*

Using the format (mm/dd/yyyy), enter the date the appointment is booked for, not the date you fill in this form.

Primary Owner(s) Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

PHONE NUMBER THE TECHNICIAN IS TO CALL TO REACH YOU ON THE DAY OF THE APPOINTMENT*

This is the phone number we will use to call you once the veterinarian has examined your pet, so please make sure you have your phone on you, and please stay close to the clinic.

Emergency Contact Name

First Last

Emergency Contact Phone Number

Pet's Information*

Pet Name: Pet's Age or Date of Birth Dog or Cat: Breed: Colour:

Does your pet have any history of aggression that has needed special restraint (example: a muzzle) or sedation (example: Gabapentin, Trazadone, etc.)*

Since owners are not able to be with their pets for appointments, please let us know if your pet has any history of ANY behavioural or aggression issues. This could include food aggression, aggression with other animals, people etc. Owners may be required to muzzle aggressive dogs before being admitted into the clinic.

Nature of the Appointment: What is your pet here for today?*

Please be as specific as possible. Please be advised that your pet will be seeing a technician for their appointment and will NOT be examined by a veterinarian. If you have any additional concerns that need to be addressed with a doctor, we request that you call in and schedule an appointment to address those concerns. Please note that charges apply to any of the following services: nail trims, anal gland expression, and/or sanitary trims

Upload a picture to file if applicable

jpg, gif, png, pdf

Is the pet currently on any MEDICATIONS, INCLUDING SUPPLEMENTS (Name, amount, frequency, last given):*

Please be as specific as possible. Do not simply state "on file." Please state the name of the medication, dose you are currently giving and when it was last given. For example: "Prednisolone 5mg - 1/2 tablet orally once a day. Last dose last night at 8pm"

Diet (EXACT brand, amount, frequency):*

Please be as specific as possible. Even if you buy the food from us, we need to know this information on this form. For example, "Royal Canin GI Low Fat: 1/2 cup twice a day."

Has your pet been fasted? If not, when was last meal?

Are your pet's vaccines up-to-date? Please note that unless a veterinarian has suspended vaccines for medical reasons, we require ALL pets to be up to date with at least the Rabies vaccine. This is a legal requirement in the province of Ontario. If your pet is not up to date, we may deny their entry into the hospital for future visits.*

Please note: the following fees will apply for NAIL TRIMS. If you would like your pet to have a nail trim at the time of their scheduled examination, please indicate below. Please note the price will vary depending on species (cat vs. dog), how the pet will behave for the procedure, and how many staff members are required to complete the nail trim. Please note: we will not know which level will be needed for each pet prior to the appointment, so if you are not comfortable with the potential charges, please decline below.*

Feline (Cat) Level 1 ($18.90), Level 2 ($29.90)
Canine (Dog) Level 1 ($29.90), Level 2 ($39.90)
Please do not trim my pet's nails during this visit.

Level 1: Calm pet, requires 1 to 2 staff members to complete nail trim

Level 2: Anxious/aggressive pet that requires at least 3 staff members, and may benefit from sedatives.

Consent*

I agree to the COVID-19 examination policy. As the owner or agent of the owner of the above animal, I hereby give my consent to Yonge-Davenport Pet Hospital to perform the procedures mentioned above.

I understand that during the performance of these procedures, unforeseen conditions may be revealed that necessitate an extension or variance in the procedure(s) set forth above. I expect Yonge-Davenport Pet Hospital to use reasonable care and judgement in performing the procedure(s). The nature of the procedure and risks involved have been explained to me and I realize results cannot be guaranteed. I am also aware that unforeseen events resulting from the procedure(s) will not relieve me from any obligation to all reasonable costs incurred regarding my pet.

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Form: Technician Appointment ONLY

TECHNICIAN APPT COVID CURB-SIDE CONSENT & ADMISSION FORM

Curb-side Appointment Acknowledgement: Please CHECK ALL.

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