Holiday Hours: CLOSED Dec. 24th & 25th; CLOSED Jan. 1st.

Two Rivers Pet Hospital

Patient Drop-Off Form

Thank you for choosing Two Rivers Pet Hospital! Please fill out the following form before your pet’s scheduled appointment. If you have any questions, please feel free to give us a call. We look forward to seeing you!

Owner's Name(Required)

First Last

Phone(Required)

Email(Required)

Patient's Name(Required)

First

Species(Required)

Dog

Cat

Breed(Required)

Age/Date of Birth(Required)

Approximate Weight(Required)

Drop-off Date(Required)

MM slash DD slash YYYY

We may need to contact you or someone you trust to make medical and financial decisions. Please provide us with an extra contact and the best phone number to reach.

Additional Contact Name(Required)

First Last

Additional Contact Phone(Required)

Reason for visit(Required)

Has your pet shown any of the following signs?(Required)

Decreased appetite

Increased appetite

Increased urination

Increased drinking

Scooting

Shaking head

Weight loss

Bad breath

Vomiting

Diarrhea

Weight gain

Coughing

Itching

Fleas

New growths

Pain/lameness

Urinary issues

Other

None of the above

If other, please explain(Required)

When did your pet last eat?(Required)

What did they eat?(Required)

Do you have any special feeding instructions for your pet?

Please list all the medications and the instructions for each

If your pet needs to be sedated, do we have permission to do so?(Required)

Yes

I authorize the Doctors and staff at Two Rivers Pet Hospital to render whatever diagnostics and therapies deemed necessary and prudent in the treatment of my pet listed above, up to the dollar amount specified here.(Required)

Two Rivers Pet Hospital will commit to the immediate medical assessment of your pet and render care, if necessary. A complete physical will be given at the earliest opportunity. Almost without exception, diagnostic tests or procedures will be needed to direct treatment and hasten the return of your pet. I am the owner or agent for this animal and have the authority to execute this consent. I authorize the veterinarian(s) and staff of Two Rivers Pet Hospital to render whatever diagnostics and therapies deemed necessary up to the dollar amount above. I authorize the use of appropriate anesthetics and other medications to be used on my pet. In the event of death of the animal, through no fault of the clinic, I will be 100% responsible for the reasonable costs thereof. I agree to pay, in full, services rendered including those deemed necessary for medical complications of otherwise unforeseen circumstances.(Required)

I have read and understand

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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Make a Veterinary Appointment
Great Falls, MT

Two Rivers Pet Hospital proudly serves the pets of Great Falls, Montana, and surrounding areas. We look forward to seeing you and your pet! You may request an appointment by clicking the button below to give us a call.

Appointment

Contact Two Rivers Pet Hospital

We’re here to help. Please complete the form below, and a member of our team will get back to you as quickly as possible.

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Location

825 6th St SW
Great Falls, MT 59404

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Contact Information

Phone: 406-453-8888
Fax: 406-453-5288
Email: support@tworiverspethospital.com

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Hours

Monday-Friday: 7:30 AM – 6:00 PM
Saturday: Closed
Sunday: Closed

Name(Required)

First Last

Email(Required)

Phone

How can we help you?(Required)

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Phone

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