Town & Country - Boarding Check-In Form

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Town & Country - Boarding Check-In Form

1
Owner Name
Date
Email
Emergency #
Contact Person
2
We prefer that you take your leash/ collar with you.If left for someone else picking up, please describe (color, material, design)
3
Yes
No
Carrier left?
Describe (if left)
Yes
No
Toys left
Description of toys left (color, material, type, design)
4
Yes
No
Food brought?
Yes
No
Feed Hospital’s Prescription Diet (Purina EN)
Please list brand/ type of food
Feeding Schedule (when/ how often)
Yes
No
Medications?
If yes, please ask receptionist for a medication logsheet.
5
Check any of the following options you desire for your pet while they are boardingFor extra play for your pet, select VIP. VIP sessions are $11.00 each. Check VIP below and indicate the number of sessions below.
BATH
VIP AM
VIP PM
NAIL TRIM
DREMEL NAILS
BRUSHOUT
6
Number of sessions
7
We can brush your pet’s teeth daily if you would like. It is $7.22 per session. Please note below if you would like us to brush teeth and the number of sessions.
Yes
No
8
Number of sessions
9
Regardless of how nice a pet care facility may be, being in a new environment can still be a stressful experience for some pets. If your pet shows signs of stress during their stay, he or she may need a mild sedative medication to help decrease their anxiety. If your pet is not eating well during their stay, he or she may need an appetite stimulant medication to encourage them to eat.
10
I give the Veterinarians at Town N Country permission to prescribe and administer calming medications to my pet during their stay, should my pet need them.I understand that there will be additional costs associated with this.
Yes
No
11
I give the Veterinarians at Town N Country permission to prescribe and administer an appetite stimulant medication to my pet during their stay, should my pet need them.I understand that there will be additional costs associated with this.
Yes
No
12
I give the Veterinarians at Town N Country permission to prescribe and administer a probiotic medications to my pet during their stay, should my pet need them.I understand that there will be additional costs associated with this.
Yes
No
13
In case of an emergency, if we are unable to contact you via the emergency contact number, do you give us permission to provide the best possible treatment for your pet?
Yes
No
14
If someone other than yourself is picking up your pet, they will be responsible for payment in full at the time of pickup. Name of pickup person
15
I have read and understand this authorization and hereby consent to the recommended care. I understand that if I cannot be reached to discuss treatment, Town N Country Animal Hospital has my permission to treat my pet as above noted. I also understand that payment is due upon services rendered. All vaccinations and intestinal parasite testing are required to be up to date. Treatment of any parasites present, including fleas present will be done at the owner’s expense.
16
Signature of Owner or Authorized Agent* This field is required.
Clear
17
Date* This field is required.
Date
Year
Month
Day
Should be Empty:

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