Name: Pet's Name:
Breed/Color: Pet's Age :
Type of Food
(Brand/Wet/Dry/Amount): Frequency of Feeding:
What flea and tick
preventative do you use? Last Applied?
preventative do you use? Last Given?
Emergency Contact and Phone numbers
Belongings : Please List (Be Specific)
Any special comments or notes?
Drop off Date Pick up Date
I understand that Town & Country Animal Hospital will use all reasonable against injury, escape or death of your animal.The hospital and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed.I understand that Town & Country Animal Hospital is not reasonable for loss or damage to any personal items left with pet.I understand any problem that develops while I'm absent will be treated as deemed best by staff veterinarians and I assume full responsibility for the treatment expense involved.