Date Today *

Date of Pick-Up *

Pick-Up Time *

8 AM - 12 PM
12 PM - 4 PM
4 PM - 7 PM

Owner's Name *

First

Last

Email *

Account Number *

Pets Boarding *

Medication *

Yes
No

Do you have second pet boarding? *

Yes
No

Pets Boarding *

Medication *

Yes
No

Do you have a third pet boarding? *

Yes
No

Pets Boarding *

Medication *

Yes
No

Do you have a fourth pet boarding? *

Yes
No

Pets Boarding *

Medication *

Yes
No

Emergency Contact *

First

Last

Emergency Phone Number *

Pet's Belongings

Special Instructions (include detailed medication directions and anything you wish the doctor to check for)

FOR YOUR PET'S HEALTH

OUR VACCINATION POLICY: To ensure the protection of all pets under our care, the vaccinations must be given once a year and be up to date for your pet to stay with us. If they have not been given at our office or proof of vaccination has not been received, we reserve the right to decline boarding if not current, and the right to call your veterinarian for confirmation of the following vaccinations:

DOGS

DALPCPV - Distemper, Adenovirus (Hepitis), Leptospira, & Canine Parvo Virus
Bordetella (Canine Bronchitis)
Rabies
CIV (Canine Influenza Vaccine)

CATS

FVRCP - Feline Rhinotracheitis, Calicivirus, Panleukopenia, & Chlamydia
Rabies

Flea Policy

I understand that all pets coming in to board will be checked for fleas and that if fleas are found on my pet(s) it (they) will be treated for fleas at my expense. *

Yes

If your pet is currently receiving a flea prevention product, please list the product's name and the last date given:

Medical Illness Policy

One of the advantages of boarding your pet(s) at a veterinary clinic is that veterinary care is readily available should the need arise. If your pet(s) becomes ill, we will call the emergency number(s) listed above regarding your pets symptoms, treatment options, and estimated costs. If no one can be reached, however, please indicate your wishes below, should your pet require treatment to relieve immediate discomfort or to resolve an important medical condition:

Please perform whatever services the doctor deems necessary for the best care of my pet until someone can be reached. This includes only non-elective treatments and any necessary diagnostics. *

Yes
No

How much do you authorize in medical care for your pet until someone can be reached? *

$100
$200
Other

If 'Other', how much? *

Do you want us to administer any medical treatment until specific authorization is given? *

Yes
No

I fully intend to pick up my pet on the above date specified. If circumstances change, I will notify the veterinary clinic of a new pick-up date. I agree to pay this bill when my pet(s) is(are) picked up.

IF WE HAVE NOT HAD ANY CONTACT FROM YOU FOR 5 DAYS AFTER THE SCHEDULED PICK UP DATE WE WILL CONSIDER THE PET(S) ABANDONED AND TAKE THE NECESSARY STEPS TO SATISFY THE SITUATION. ADDITIONAL CHARGES WILL BE ADDED FOR THE TOTAL TIME THAT THE PET(S) ARE IN OUR CARE. . YOU WILL BE RESPONSIBLE FOR THE TOTAL BILL.

Signature of Owner or Agent for the Pet(s) *

Date *

Boarding Agreement Form