Sick animal intake Form in Corsicana, TX

Owner’s Name:*

Pet's Name:*

Email*

I will be:

Staying in the parking lot until my pet is ready
Dropping off my pet

My pet is experiencing (check all that apply):*

Please specify:

When did your pet’s symptoms start?*

Have there been any recent changed to your pet’s diet? What does your pet eat currently? Does your pet ever receive any “human food,” ever get into the trash, or chew up toys?

Please describe your concerns about your pet or any further relevant information on the symptoms they are experiencing.

Depending on your pet’s symptoms, the doctor may choose to run tests on your pet to try to determine what is wrong. Please fill out this section of our form in order to facilitate the fastest possible care for your pet. Tests will only be run if the doctor feels they are necessary, this just allows us to complete necessary testing faster- for your convenience.

Bloodwork costs $120 and gives us a good idea of your pet’s kidney, liver, and pancreas function, shows us if they are anemic or if they have an infection, among several other things. Please check one:*

Ask me before running this
You can run this test if the doctor feels it is warranted
Do not run this test (Reminder: this limits our ability to tell you what is wrong with your pet)

Radiographs (X-rays) cost $120 and help us to diagnose many different conditions ranging from broken bones, heart failure, pneumonia, foreign objects in the GI tract, bladder stones, etc. Please check one:*

Ask me before running this
You can run this test if the doctor feels it is warranted
Do not run this test (Reminder: this limits our ability to tell you what is wrong with your pet)

Urinalysis costs $66 and can check your pet for a urinary tract infection, and also assist us in diagnosing many health conditions such as urinary crystals and stones, diabetes and kidney failure. Please check one:*

Ask me before running this
You can run this test if the doctor feels it is warranted
Do not run this test (Reminder: this limits our ability to tell you what is wrong with your pet)

Fecal Flotation costs $36 and allows us to check your pet for intestinal parasites (worms). Please check one:*

Ask me before running this
You can run this test if the doctor feels it is warranted
Do not run this test (Reminder: this limits our ability to tell you what is wrong with your pet)

FIV/FELV TESTING looks for commonly transmitted viruses in CATS and costs $48. 4DX TESTING checks DOGS for heartworms and tick-borne diseases and costs $42. Please check one:*

Ask me before running this
You can run this test if the doctor feels it is warranted
Do not run this test (Reminder: this limits our ability to tell you what is wrong with your pet)

I understand by signing this form, I am consenting to my pet being treated by Animal Care Clinic and acknowledge that I am responsible for all charges incurred.