Hebron Cat Hospital

1617 W. Hebron Pkwy
Carrollton, TX 75010-6334

(972)394-9228

hebroncathospital.com

 

Drop Off Form

 

Please fill out a new client form if your pet has never been to HCH. Drop-offs are for established patients, if you're a new patient, you must allow for an approximately 30 minute appointment for an initial exam and consult with the doctor, then your pet may stay with us for treatment. Established patients should allow approximately 10 minutes for a thorough history of the current problem.

If you would like, we also have printable forms available for you to print out and bring in with you.


Drop Off Form

Name (required)
First Name (required)
Last Name (required)
Your Pet's Name (required)

Phone Number (where you will be available all day) (required)
Phone TypePhone Number (required)
May we use the number above to text you information about your pet?
yes
no


Alternate Phone Number
Phone TypePhone Number
May we use the number above to text you information about your pet?
yes
no


E-Mail Address :
Has your pet been seen by HCH Previously? (required)
(if not please fill out the "New Client Form")
yes
no


What is the main reason for your visit?

When was your pet's last meal?

What did he/she eat?

What medications (if any) has your pet received in the last 24 hours?
My pet has had NO medication(s)/supplements in the last 24 hours
Name of medication(s)

Amount Given

Time Medication(s) Given

Is your pet sensitive or allergic to any medications or food?
yes
no


Please list any known sensitivities/allergies

Vaccinations
If your pet is due for vaccines,
Please update all vaccines
Please call me to discuss which vaccines to give


Needed Medications
Does your pet need any Heartworm or Flea Control products?
Revolution (cats)
Sentinel (dogs)
Heartgard (dogs)
Capstar


Please Specify Amount:
1 month
3 months
6 months
other


Any Additional Medications your pet needs refilled:

Please describe the problem(s) your pet is having,
Any pertinent history leading up to the current condition, any previous major medical problems.

Would you like us to: (required)
(Please note, if we have not seen your pet before, we will need to contact you prior to starting any treatment.)
treat your pet after examination?
call you with the findings of the examination and an estimate of treatment cost prior to our treating your pet?


In the event that my companion animal arrests while at Hebron Cat Hospital,
I authorize the following CPR code: (required)
(by checking the box you are initialing your choice)
CPR: Normal CPR involving chest compressions, oxygen therapy and medications such as epinephrine, atropine, etc.
DNR: No resuscitation


Please Read Carefully
Agreement:
PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PERFORMED In admitting my pet(s) for diagnostics, treatment, or surgery, I authorize the veterinarians of Hebron Cat Hospital and their support staff, to administer such treatment(s) and/or perform such diagnostic or surgical procedures as deemed necessary.
I understand that if any fleas are found on my pet, I will be charged for flea medication.
By initialing below I am giving my approval to the above statements. (required)


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