Drop-Off Treatment Consent | High Prairie Veterinary Services

406-525-3878 HighPrairieVetOffice@gmail.com

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Drop-Off Treatment Consent Form

Please complete the form below.

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Drop-Off Treatment Consent Form

Client Name *

First

Last

Cell Number *

Home Number

Pet Information

Pet Name *

Species *

Breed *

Color *

DOB/Age *

Weight *

Sex *

Male
Male Neutered
Female
Female Spayed

In-Patient Pet Questionnaire

Does your pet show sign of illness today? *

Yes
No

If yes, please explain *

Is your pet currently taking any medications? *

Yes
No

If yes, please explain *

Please list previous surgeries:

Has your pet had any previous reactions to anesthesia? *

Yes
No

If yes, please explain *

Any behavior concerns (i.e., biting, timidness, special handling):

Belongings left with your pet today

Please check off all procedures accordingly

Bloodwork *

Yes
No

X-Rays *

Yes
No

Administration of any/all medications *

Yes
No

Sedation, if needed for safety of your pet *

Yes
No

IV Catheterization with administration of fluids *

Yes
No

Life saving measures *

Yes
No

Humane euthanasia *

Yes
No

Vaccination History

Parvo/Distemper Combo

Feline Combo

Rabies

Rattlesnake

Heartworm Test

Fecal Float

Treatment Authorization - Please read and initial each statement below:

Payment is due at time of service and this form must be complete.

I verify I am the owner (or authorized agent for the owner) of the above-named pet and authorize the above procedure to be performed. *

I understand

I authorize the use of anesthesia and other medication as deemed necessary by the veterinarian and understand that clinic personnel will be employed in the procedure(s) as directed by the veterinarian. High Prairie Veterinary Service (HPVS) will use all reasonable precautions against injury, death, or escape of my pet. *

I understand

I accept the risk inherent in any anesthesia or surgery and release HPVS of any liability associated with the procedure. *

I understand

I further understand that there may be additional, deemed necessary, treatment or expenses upon further examination and commencement of my pet’s treatment plan. If my pet has fleas, ticks, mites, or internal parasites, I understand that I will be charged with the cost of removing them. *

I understand

Signature of Owner *

Clear Signature

Date *

We proudly serve the pets of Wolf Point and beyond.

Our philosophy is to provide excellent customer service and first rate pet care. We strive to create a relaxing-friendly environment for you and your pet. Our clinic is comfortable, pet-friendly, and calm.

CONTACT US!

Our veterinarians are highly trained in the treatment of any health condition. We’re a full-service mixed animal vet clinic with amenities designed to help you and your pet feel relaxed and at home in the company of our welcoming staff.

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Phone



email

HighPrairieVetOffice@gmail.com

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address

420 Cascade Street
6182 Hwy 13 (mailing)
Wolf Point, MT 59201

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HOUR OF OPERATIONS

Monday – Thursday: 8am – 6pm
Friday: 8am – 5pm
Saturday – Sunday: Closed

We Can't Wait to Meet You!

Ready to schedule your next appointment? Visit out our online appointment request form by clicking below.

We are passionate about working together with you in the best interest of your pet.

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please contact us if you have any questions or suggestions.

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