Boarding Check-in

 Boarding Check-in

Last name:___________________  First name(s): _____________________

Address: ______________________________________________________

Home phone: _________________ Cell phone(s): _______________________

Emergency Contact(s): ___________________________________________

Drop-off date: ____________ Pick-up date and time: ____________________

 

Pet name: _______________

Species: ________________

Breed: __________________

Color: __________________

Sex: _________ Altered? ___

Date of Birth: ____________

 

Date of last exam: ________

Date of last vaccinations:

Cats:    FVRCP______

FELV________ Rabies ______

Dogs:   DHPP________Rabies______

Bordetella_________

 

Boarding instructions:

  • With my pet, I also dropped off (circle):  Food            Medications         Bed              Bowl(s)           Toy(s)                         Leash              Other: _________
  • Feeding instructions: Please list type of food, quantity, and frequency:

_______________________________________________________________________________________________________________

  • Medications:  Please list name, dose, and frequency:

_______________________________________________________________________________________________________________

 

Boarding Policy/Consent:

I understand that:

  • Though every attempt is made to return belongings in their original condition, I assume full responsibility for any lost or damaged personal belongings (including leashes, collars, bedding, toys, etc).
  • I must provide proof of a current physical exam (within one year) and vaccination status.  Special exceptions may be made only by doctor approval.
  • If my pet has fleas, flea protection will be used so as not to infest other patients in the clinic.  The cost will not exceed $23.00.
  • If an emergency occurs, and I cannot be reached (or my emergency contact cannot be reached), I authorize the doctor to do what s/he deems necessary for the care of my pet.
  • My pet will be walked at least 3 times daily.  If s/he becomes soiled, s/he will be cleaned.  Any additional bathing will be at my expense.
  • All charges are due at time of pick up.

 

Signature: ____________________________________

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Veterinarian/Owner of Pismo Beach Veterinary Clinic

Posted in Clinic Forms
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