Client’s Name:*Check In Date* MM slash DD slash YYYY Pet’s Name(s):*Expected Check Out Date MM slash DD slash YYYY Time* Before 1:00PM After 1:00PM 1. My pet is current on vaccinations per hospital protocol. If vaccines were administered by another veterinarian, I am responsible for providing documentation prior to boarding check-in; otherwise vaccines will be re-administered at my expense. Please update my pet’s vaccinations and wellness examination at my expense to meet hospital protocols. 2. My pet has not had an approved Flea & Tick Prevention, please administer to my pet at my expense. My pet been treated with an approved Flea & Tick prevention. Product:Date applied: MM slash DD slash YYYY Vectra 3D for dogs/Revolution for cats will be applied at my expense 30 days after the date above if my pet is boarding at that time.3. No, I am not leaving any belongings. I am leaving the following personal belongings described. Belongings Collar Leash Blanket / Bed Dish(s) Carrier Food Medications Toys Treats Other 4. Please feed my pet ANP original dry while boarding (included with boarding). I will provide my pet’s regular food to be fed while boarding. My pet requres a Prescription or Canned Food diet. Please provide the food following food at my expense: FoodFeedCupsTimes/day List 5. Please provide the following Grooming Services for my pet at my expense. Ask for estimates. Grooming Services as I have scheduled in advance (Cost start at $75.60). Bath and brush (Cost start at $21, increases based on weight.) No, I decline grooming services for my pet. Other Pedicure Nail Dremel Clean ears Express Anal Glands Dematting Furminator Deshed Treatment 6. Please medicate my pet while boarding (Cost $2.10/admin.) Please refill my pet’s medications: Please refill my pet’s medications No, my pet is not on medications. Medicationgiventimes/day 7.Please provide the following services / procedures for my pet. Please call me with an estimate before providing treatment. No, my pet does not need any other services. Services: Spay/Neuter Dental Cleaning Microchip Implant Wellness Exam/ Vaccines Bloodwork Urinalysis Radiographs Please Check: Allergies / Skin Ears Arthritis / lameness Weight Other I am aware of and understand Southwest Pet Hospital policies including, but not limited to: Check out time is at 1PM. I will be charged for an additional day of boarding if I pick up my pet after 1PM. No Flea/Tick Policy – treatment will be at my expense Necessary symptomatic medical treatment (i.e. diarrhea medication, etc.) of my pet while boarding will be at my expense. Southwest Pet Hospital is not responsible for lost belongings. The staff is not on the premises 24 hours a day. If an emergency arises, I authorize the doctors at Southwest Pet Hospital to perform the necessary procedures. I understand that they will try to contact my emergency contact in the case of an emergency at the number given below prior to treatment. I understand that I will be responsible for these charges. Signature of Owner / Authorized Agent*Emergency Contact & Phone # (Mandatory)*Date* MM slash DD slash YYYY
