Drop-off Form

FAMC DROP-OFF CONSENT FORM

* Indicates required field

Name *

First

Last

Pet's Name *

Reason for visit and any questions you have for the veterinarian: *

Please list all of your pet's medications, supplements and flea control *

Please tell us what food your pet eats. How is their appetite? *

Any changes in water consumption? *

Are urination & defecation normal? If not, please describe what is going on. *

Any vomiting or diarrhea? If yes please describe what is going on. *

Any changes in weight? *

Any coughing or sneezing? If yes, please describe what is going on. *

We love giving out treats. Is there anything your pet can't have while with us? *

Please select below how you wish us to proceed if any problems are found with your pet, or if any develop while your pet is in our care.

Choose One: *

Any tests/treatments deemed necessary for my pet. Any tests/treatments deemed necessary for my pet, up to chosen dollar amount. Do not perform any tests/treatments after the exam until you have spoken with me.

Chosen dollar amount: *

If sedation/anesthesia is required: I hereby authorize Fidalgo Animal Medical Center to perform anesthesia, treatment and/or surgical procedures as deemed necessary for my pet. I understand the nature of the procedure and that there may be risk involved. No guarantee has been made as to the result or cure*

Select One *

Your pet will receive an examination while in our hospital. Hospitalization fees may apply (1/2 day: $25.50).

If fleas or flea dirt are present on your pet, we will apply a quick acting Capstar flea treatment ($11.00).

Choose Any *

I hereby grant FAMC permission to take photos and/or video of my pet and/or myself, and to publish those images,with or without my name and/or my pet’s name, for any lawful purpose, including but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I waive any rights of compensation associated with the use of my/my pet’s image(s) and name(s) for the purposes outlined above.Option 1

Thank you for providing us with information about your pet. It will help us streamline the curbside appointment process as much as possible. We greatly appreciate your patience and understanding with our new protocols.

I affirm that I am the owner or agent of the animal names above and I am over 18 years of age. My electronic name entry herein constitutes my legal signature and authorizes Fidalgo Animal Medical Center to examine my pet. I understand the doctor will contact me after she/he has examined my pet, to discussed their findings and recommendations. I authorize my pet to leave my custody and enter the clinic in the care of a clinic team member.

Name *

First

Last

Vehicle make/model/color: *

Phone number for the doctor to call: *

Submit

FAMC DROP-OFF CONSENT FORM

FIDALGO ANIMAL MEDICAL CENTER

office hours

In Case of Emergency

3303 Commercial Ave
Anacortes, WA 98221
FAMC@FIDALGOVETS.COM

Our Partners in care

FAMC DROP-OFF CONSENT FORM

FIDALGO ANIMAL MEDICAL CENTER

office hours

In Case of Emergency

3303 Commercial AveAnacortes, WA 98221FAMC@FIDALGOVETS.COM​​

Our Partners in care

3303 Commercial Ave
Anacortes, WA 98221
FAMC@FIDALGOVETS.COM