Forms

Date of the Appointment:*

Please let us know 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

Today's Phone Number: THIS IS THE NUMBER THE VET IS TO CALL YOU 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:

Upload a picture to file if applicable

jpg, gif, png, pdf

Presenting Complaint: What is your pet here for today?*

Duration of Time (When did the problem start, has it changed, better, worse, same?):*

Diet (EXACT Brand, amount, frequency):*

Any Vomiting/Diarrhea/Coughing/Sneezing:*

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

Any changes in appetite or drinking/urinations (drinking or peeing more often?):*

Any other pets in house? If yes, are they affected?*

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

Indoors/Outdoors?*

Are your pet's vaccines up-to-date?*

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 following procedures:*

Please note: the following fees will apply for NAIL TRIMS starting December 1, 2020. 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 ($9.90), Level 2 ($18.90), Level 3 ($29.90)
Canine (Dog) Level 1 ($19.90), Level 2 ($29.90), Level 3 ($39.90)
Please do not trim my pet's nails during this visit.

Level 1: Calm pet, only one staff member needed to complete nail trim

Level 2: Calm pet, but at least 2 staff members needed to complete nail trim.

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

Additional Services: Please note any additional services that you would like us to perform while your pet is at the clinic. Additional fees may apply:

NAIL TRIMS - EXTRA CHARGES APPLY

ANAL GLAND EXPRESSION - EXTRA CHARGES APPLY

SANITARY TRIM - EXTRA CHARGES APPLY

I, the owner of the pet mentioned above consent to (SELECT ONE BELOW):*

A. The veterinarian being authorized to administer or dispense all items listed above as well as any other treatments or diagnostics the vet deems necessary without further authorization on my part.
B. The veterinarian MUST CALL ME BEFORE performing or administering any treatments or diagnostics BEYOND A PHYSICAL EXAM AND ITEMS LISTED ABOVE (including ones I have selected that may incur additional charges).

Consent*

I agree to the COVID-19 examination policy.

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.

Contact Us

Forms

COVID Consent Form

Find us on Facebook

Make an Appointment

In the News

Adopting Rescue Dogs Responsibly

Recent Reviews