Name *
Email *
Phone *
Dates
Pick up and drop off times are during regular clinic hours.
Check-In Date *
Check-Out Date *
Vaccinations
Is your Pet up to date on the following vaccines?
Feline FVRCP Yes No Update today
Feline Leukemia Yes No Update today
Rabies Yes No Update today
Bordetella Yes No Update today
DHPP/L Yes No Update today
I understand that state law requires a rabies vaccination for all pets. I also understand clinic policy requires Distemper/Parvo, Rabies, and Bordetella vaccinations for dogs and/or Feline Distemper and Rabies vaccines for cats to be considered current on vaccinations.
Health & Medications
Is your pet on heartworm prevention? *Yes No
Has your pet been checked for intestinal parasites in the last 12 months? *Yes No
Is your pet taking any medications? If yes, please provide the name(s), dosage(s), and directions.
I understand that if evidence of fleas are present, flea treatment will be applied upon admission. There is a fee charged for this service. *Yes No
Please list all belongings left with your pet. *
Feeding
Diet *Canned Dry Kennel Provided Owner Provided
Feeding Schedule *Morning Afternoon Evening
Food Brand
Amount Fed? *
Last ate? *
Veterinary Services
Veterinary Services requested while boarding:
Physical Exam Fecal Exam Heartworm Test Update Vaccinations as above Nail Trim Express Anal Glands Other
If requesting an exam, please explain the reason for the exam below.
Has your pet been vomiting, coughing, sneezing, having diarrhea, or any other illnesses or injuries in the past 30 days? If yes, please explain. *
Any other notes to the Team about your pet:
Agreements & Authorization
I understand you can not guarantee the health of my pet. I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limited to weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea, and fleas. I understand all pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owner/agent’s expense. If vaccinations were performed elsewhere, I will provide written documentation of the vaccinations administered by a licensed veterinarian. I understand that in the event of illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options, but may not be able to contact me immediately and are therefore authorized to initiate appropriate treatment until or my agent can be reached.
If any problem is observed or develops: * Please treat my pet as required; you need not call me. Perform only emergency & supportive care. Notify me for permission to begin any other treatment. Do not perform any treatment/diagnostics until I am notified and consent for you to evaluate and treat as recommended.
Should an emergency arise, I authorize the medical staff to sedate my pet and/or perform such emergency procedures as may be necessary for the health of my pet until I can be notified. I agree to pay, in full, all charges for necessary services rendered. I understand that the clinic is not responsible for loss or damage to personal items left with my pet including but not limited to leashes, collars, toys, and bedding. The clinic is to use all reasonable precaution against injury, escape, or death. The clinic and staff will not be held liable for any circumstances that may develop, provided reasonable care and precautions are followed. I understand any issues that develop will be treated as notated above and I assume full responsibility for all expenses incurred. I will notify the hospital if my arranged pickup date changes. If I neglect to pick up my pet within 5 days of the date scheduled for discharge and do not notify the clinic within that time period, you may assume that my pet is abandoned and are hereby authorized to treat my pet as a surrendered pet and will follow the hospital policy for such. I understand that if my pet is aggressive or anxious, medications may be given at my expense.
Signature *
Clear
Date *
Name and phone number of Responsible Party to be reached in an emergency *
