Illness Drop Off Form

Please fill out this form if you are dropping off your pet for an illness related problem. A doctor or other veterinary staff will need to contact you in regards to the exam your pet will receive today. Please leave the best contact information for today at the bottom of this form.

Brief History

I hereby authorize the veterinarian and Fitchburg Veterinary Hospital to perform the procedure or treatment(s) listed above. I am the legal owner/agent for the animal on this form. I understand full payment is expected at time of discharge.