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Would your pets like to board together or separately (This is only with your permission)

Together
Separately

Your Name

Phone Number

Email

Emergency Contact: Name and Phone Number

This person should be able to pick up your pet if needed.

Address

City

State

Zip

Pet's Name

Other Pets Being Boarded

Drop Off Date

Pick Up Date

Please list all belongings left with your pet(s): (list collar and leash)

Would you like your pet to eat the clinic diet or will your provide your pet with their own diet?

Clinic Diet
Owners Diet

If you checked Owner's Diet, please list the food that will be provided.

Please list any food allergies your pet may have

Feeding Schedule

Measurements

Cups
Cans

Special Instructions

Treats Brought from Home (type and instructions):

Will you bring a carrier for your pet?

Medications

No medication
Brought medication
Administer clinic medication
I administered this mornings/today's medications before arrival

List Medications

Please list any medications your pet may need to take (include when your pet needs their dosage)

When should your pet be groomed?

What medical services does your pet require?

Information about your pet's behavior

Eats toys or bedding
Fearful of storms/fireworks
Dog aggressive

Vaccination Requirement

Vaccination Requirment

Boarding pets must be current on all required vaccinations and free of internal and external parasites, or they will be treated upon admission at owners' expense.

Date prevention administered:

Medical Illness Policy

One of the advantages of boarding your pet(s) at a veterinary hospital is that medical attention is readily available should the need arise. IF your pet becomes ill, we will call the emergency number regarding your pet's symptoms, treatment options, and an estimate of additional costs. If no one can be reached, please indicate your wishes below should your pet require treatment to relieve immediate discomfort or to resolve an important medical condition. Please select one of the options below:

Select One:

Initiate treatment without notice.
Attempt to contact me. If I'm not available, start treatment, but don't exceed $200 without speaking with me first.
Do not initiate treatment unless I authorize.

Boarding Release

In the event my pet becomes ill, I authorize the attending veterinarian to administer treatment as is considered therapeutically and/or diagnostically necessary. I also consent to the administration of such anesthetics, as are necessary and surgical procedures of an emergency nature. I understand that the Doctors or Staff will make every effort to contact me prior to any treatment or medication over a cost of $100.00 and or surgical care of major medical emergency.

I agree to pay for any and all vaccinations that are deemed necessary for my pets stay.
If a medical problem is discovered during my pets stay, I understand that care will be provided I and agree to pay for all necessary treatment.
I agree to pay for flea treatment if fleas or flea dirt are found on my pet on admission or during my pets stay.
I understand that boarding rates are charged by the night.
I agree to pay in full for all services rendered at the time of discharge.
I understand that there are no pick ups outside of the Normal Business hours.

Acceptance

I acknowledge and agree to the terms and conditions of service