BOARDING ADMISSIONS FORM

Client Name: __________________________________________  Date:_____________ Emergency Contact Name/Phone Number:___________________________________________                        

Pet's Name:_____________________________________________________________                                        

Date of Last Services:        

   DOG                                                  CAT

Rabies: ____________________ Rabies: ____________________

Distemper/Parvo:_____________ FVRCP-C: __________________

Corona: ____________________ Feline Leukemia: _____________

Bordetella: __________________            FIV: _______________________

Lepto: _____________________

Heartworm Check__________    *Must be current 1yr. for adult, 3 wks for puppy/kitten.

RX Heartworm Med_________   **Must be current within 6 months for adult, 3 wks for <12m.

Fecal Exam_______________                (Current Heartworm check and prevention is                                                                                      mandatory with vaccinations.)

Please provide the following service(s) while boarding:

     Canine Vacc:     RABIES      DHLPP      CORONA      BORDETELLA      LYMES      PARVO

     Feline Vacc:      RABIES      FVRCP-C   FELEUK

     Fecal                 FeLeuk Test        Express Anal Glands        Heartworm Check

     Bath                  Ear Cleaning       *Physical Exam                  Nail Trim

     Dental Cleaning                 Spay                 Neuter                  Bath w/flea control

     Other____________________________________________________________     *Mandatory with vaccinations.

Medication to be given while boarding     

(A medication administration charge may apply.)

1.___________________________ Instructions_______________________________________       2.___________________________ Instructions_______________________________________      3.___________________________ Instructions_______________________________________      

Items left with your pet(s):_________________________________________________________  

(Please make sure all items are received at your pick-up time.)

Amount of food and frequency fed: _________________________________________________

Special Requests:_______________________________________________________________

Date and Time to be picked up:_____________________  am_______  pm____

All animals entering the hospital must be current on vaccinations, free of external parasites (fleas, ticks, etc.) and internal parasites. If not, they will be treated upon entry into the hospital at the owner's expense.

A service charge of 1 1/2 % per month. 18% APR will be added to all overdue accounts. Also liable for all legal and collection fees.

I authorize the hospital to do whatever is medically necessary should an illness or emergency arise, and I assume financial responsibility for such treatment. Payment is required when pet(s) are released.PETS ARE RELEASED ONLY DURING REGULAR OFFICE HOURS.  If I neglect to

pick up my pet within 5 days of the above date, you may assume that the pet(s) is/are abandoned and you are hereby authorized to dispose of the pet as deemed best and necessary.

Signed                                             Date: __________________________