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Client ID:
Patient ID:
Client Name:
Name:
Spouse/Partner:
Species: DogCatOther
Address:
Breed:
City:
State:
Zip:
Sex: MaleFemale
Phone #:
Spayed/Neutered? YesNo
Email Address:
Color:
Weight:
Birth Date:
Doctor: Clinic
All pets are given a boarding check-in exam by a technician. If you would prefer a complete physical examination by a doctor, please let us know.
All pets are fed Royal Canin GI Low Fat unless you provide your own food.
My pet has been fully vacinated within the last 12 months. If I cannot show proof of such vaccinations, then I give permission for the hospital to administer vaccinations required for the boarding of my pet(s). All pets must be free of fleas and ticks or they will be treated upon admission at the owner's expense.
In the case that your pet needs medical attention during their stay, please indicate the dollar amount of medical treatment authorized.$100$400Any AmountOther $
I have read and understand the authorization and consent: YesNo
Begin boarding date:
End boarding date:
Telephone number(s) or email where the owner can be reached:
Special diets, medications or services to be performed while boarding (please note, an additional fee applies):
Last date these medications were given:
Would you like your pet to have a bath or groom? YesNo
Date:
Owner's Name:
