Drop-Off Examination Questionnaire

APPOINTMENT

Drop-Off Examination Questionnaire

Please complete the form below prior to your appointment.

Drop-Off Examination

We have arranged for you to leave your car there to allow the doctor to examine your cat as soon as possible today. Please read through the following questions, and answer any that may apply to your cat today. The more thorough and accurate you are, the better we can care for your cat.

I hereby authorize The Cat Doctor of Monroe and Dr. Kimberly Scutchfield to perform care for my pet. I acknowledge that I am the owner/appointed caregiver of the animal described above and am legally able to consent to care for my pet. I understand that any procedure poses a risk to my pet regardless of health status. In the event of unforeseen complications, I give permission for the doctors and staff to take reasonable measures in treating my pet and accept all charges that are incurred as a result of such action. I further authorize The Cat Doctor of Monroe and staff to release my pet's medical records to another veterinary provider if requested by another veterinary provider.

I acknowledge that I am leaving my pet under the care of the staff at The Cat Doctor of Monroe. I understand that this facility is not staffed 24 hours per day and is not staffed on the weekends or holidays and that there could be complications that may become serious if not detected right away and may result in further injury, illness, or death to my cat. I understand that I have the right to transfer my cat to an emergency center for 24-hour care at any time. I also understand that if an emergency does arise where I cannot be reached, the doctors and staff of The Cat Doctor of Monroe have the authority to treat my cat as deemed necessary to stabilize him/her. I understand the doctor will contact me after they have examined my cat to discuss recommended diagnostics and treatment and will have an initial estimate of charges. I can be reached at

If I cannot be reached at this number, I authorize initial diagnostics, including radiographs and blood work if indicated, for my cat. Further, if I cannot be reached, I authorize initial treatment, including fluid support and other supportive medications, is started as indicated for my cat. I authorize anesthesia, surgery, and medications if needed for treatment, either due to the nature of the problem or my cat’s aggression. I understand and accept that when anesthesia is involved, there are always inherent risks, including death. I understand payment is due when my cat is discharged; however, a deposit may be required after an estimate is prepared and discussed. I accept financial responsibility for charges incurred for this cat. I understand that I will be charged for flea medication, and a dose will be applied if evidence of fleas is found on my cat today.