Drop-Off FormEast Emporia Veterinary Clinic

For busy clients and flexible scheduling, we offer drop-off appointments. This form lets us know what your pet is being seen for, your concerns, and any medications or treatments they’re receiving.

Fill Out the Drop-Off Form

Client Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Pet's Name *

Breed *

Color *

Age/DOB *

Sex *

Male
Neutered Male
Female
Spayed Female

Permission to do lab work at doctor discretion? *

Yes
No, please call first

Permission to do X-rays at doctor discretion? *

Yes
No, please call first

Today's Date *

Owner Signature *

Clear Signature

Emergency Telephone Number *

Age/DOB Emergency

Adapted from a form approved by the American Veterinary Medical Association 1982

Please plan to drop off your pet after 9:00 AM if possible.
Call us at (620) 343-7682 with any scheduling needs.

Drop-Off FormEast Emporia Veterinary Clinic

Fill Out the Drop-Off Form

Schedule Your Pet’s Visit Today

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