Drop Off Questionaire

Name: Somerset Animal Hospital
Address: 715 Rivard St., Somerset, WI, 54025, United States
Telephone: 715-247-2324
Price range: $

Thank you for choosing Somerset Animal Hospital! Please fill out the drop off questionaire form below.

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Drop Off Questionaire Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 715-247-2324 for a faster response.

*Clients that haven't been seen within the last year are required to pay $90 down when pet is dropped off.*

Do you already have a drop off scheduled? *

Please call us at 715-247-2324 to schedule a drop off appointment before completing this form.

When is your appointment? *

Date

Time

Pet's Name *

Owner's/Today's Contact Name *

First

Last

Email *

Phone Number *

What is your primary concern today? How long has this been going on/when did it start? *

Any vomiting? *

How often is your pet vomiting? *

Any changes in urinating or defecting habits? *

Please explain: *

Any changes to your pet's eating or drinking habits? *

When was the last time your pet ate and what? *

Does your pet have any pre-existing health conditions, vaccine/medication reactions, or allergies that we should be aware of? *

Please explain: *

Any changes in your home recently? (Ex: new people or pets, moving, remodeling) *

What changes in your home? *

Is your pet on any medications or supplements? *

What medications or supplements? *

Amount authorized before calling (Today's visit will start at $106. X-rays range from $75-$150+ and bloodwork starts at $150):

I understand that the bill is due at the time of pick up.

Signature *

Date *

Request an Appointment

We're excited to meet you! Request an appointment online today.

Appointment

Contact Us

Let's Get In Touch

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Address

715 Rivard St.
Somerset, WI 54025

Contact

P: 715-247-2324
F: 715-706-6100
E: Smallpets54025@gmail.com

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Hours

Mon - Fri: 8:30AM-5:30PM

Sat & Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Phone