702-395-1800
Cheyenne West Animal Hospital
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  • Home
    • Updates Regarding COVID-19
    • Our Services >
      • Internal Medicine
      • Dental Care
      • Diagnostic Medicine
      • Wellness Exams
      • Surgery
      • Grooming, Boarding & Day Care
      • Hospice & Euthanasia
      • Pharmacy & Pet Supplies
    • Office Visits >
      • Wellness >
        • Pet Care Plan
        • Flea, Tick & Heartworm
        • Behavioral Medicine
      • Exams
      • Vaccinations
      • House Calls
      • Emergency Care
      • Microchipping
  • Covid 19 - Pandemic
  • Our Staff
    • Doctors
  • Client Center
    • ONLINE STORE
    • Client Forms >
      • Anesthetic Release Form
      • Boarding Release Form
      • Consent For Treatment
      • Drop Off Form
      • Euthanasia Consent Form
      • New Client Form
    • Helpful Pet Links
    • Petly
    • Downloads
  • Client Reviews
  • Contact

    Medical Drop-Off Form


    Please check all that apply

    I, the undersigned, certify that I am the owner, or authorized agent for the owner, of the pet described above.  I authorize the doctor and assistants to perform the procedure(s) listed above, including administration of pain relief medications, sedatives, and/or anesthetics, as well as any necessary medical, radiological, surgical, nursing, diagnostic, and/or emergency care for the pet.  I have been advised as to the nature of the procedures and the potential risks.  I also understand that no guarantee of successful treatment can be made and assume full financial responsibility.
     
    I agree to hold Cheyenne West Animal Hospital harmless, in the absence of negligence, from and against any and all liability arising out of the performance of any of the procedure(s) referred to above.  I have been informed that Cheyenne West Animal Hospital is not staffed 24 hours a day. I understand that if my pet requires overnight supervision post-surgically, or hospitalization, my pet will  be referred to the appropriate emergency hospital.
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Hours of Operation

Monday - Friday: 8:00 AM - 6:00 PM
Saturday: 8:00 AM - 4:00 PM 
Sunday: CLOSED
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Cheyenne West Animal Hospital

3650 N Buffalo Dr
Las Vegas, NV 89129 staff@cheyennewest.com 
tel: (702) 395-1800
​fax: (702) 395-1883

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