South Shores Pet Clinic - Pet Boarding Form

1
Pet Boarding Form
2
We are happy to care for your pet while you are away.

To make “check in” quick and easy, please complete the forms on the next two pages, and give them to the receptionist when you bring in your pet. By answering each question, you are providing us with information that will help us provide the best care for your pet. Your pets will be under the loving care of our technicians and doctors while boarding with us.

While visiting, your pet will stay in a private, comfortable, and temperature controlled kennel.Clean fresh water is provided at all times. Your dog will be walked twice during the day. Cats stay inside with clean personal litter pans. Your pet will be fed a premium diet (Hills Science Diet) each day. Please indicate any specific dietary needs on the reverse side. If you indicate a special diet, please remember to bring enough food for your pet while you are away.
3
To ensure the health of every pet

All dogs are required to have current Vaccinations for the following:

🐕 Distemper
🐕 Parvovirus
🐕 Rabies
🐕 Bordetella (Infectious Tracheobronchitis)

All cats are required to have current Vaccinations for the following:

🐈 FVRCP/Upper Respiratory
🐈 Rabies

(Please bring proof of vaccinations if we are not your veterinarian)
4
** To further protect all pets, any boarding animal that is found to have parasites such as worms, fleas and ticks will be treated at the owner’s expense.

You can pick up your pet Monday through Friday from 8:00 AM to 6:00 PM and Wednesday
from 8:00 AM to 8:00 PM and on Saturday from 8:00 AM to 3:00 PM. Please be sure to tell us what time you will come to pick up your pet so we can be sure they are clean and ready to go.

Please call in advance for reservations, as boarding space is limited, especially during the holiday seasons.

We enjoy caring for your pet.
5
Owner’s Name
Pet’s Name
Telephone number while away
Emergency Contact
Phone Number
Email Address
6
Date you are bringing your pet
Date
Year
Month
Day
7
Approximate Time
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
8
Date you are picking up your pet
Date
Year
Month
Day
9
Approximate time (within 2 hours)
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
10
If you will not be picking up your pet from boarding, please state who is picking up?
11
#1 Please indicate any medication you are bringing for your pet and how frequently it should be given
(A) Medication
How Often
(B) Medication
How Often
(C) Medication
How Often
(D) Medication
How Often
12
Need Another Sheet For Given Medication List?
YESNO
13
#2
(E) Medication
How Often
(F) Medication
How Often
(G) Medication
How Often
(H) Medication
How Often
14
Please select the letters indicating which medications that have been given today
A
B
C
D
E
F
G
H
15
Are you providing us with food for your pet?If not, we feed Hills Science Diet at no charge. We DO sell Hills Prescription Diet that can be charged to your account.
Yes
No
16
Feeding instructions (Frequency/Quantity)
17
Has your pet eaten yet today?
Yes
No
18
Accommodations
19
Dogs
Large
Medium
Small
Double Occupancy
20
Cats
Double Condo
Single Condo
21
To protect all pets, each dog and cat must have current vaccinations and an annual
comprehensive physical exam. If your pet is due for any vaccinations, they will be
given while boarding for the standard vaccine fee. If they have been vaccinated
elsewhere and are up to date, please provide us with a written record.
22
Please indicate any additional services we can provide for you pet below.
Bath
Extra walks per day :
Fecal exam       and deworming, if positive
Nail trim
Heartworm test
Other       If Other, please specify
23
How did you learn about our boarding facility?
Personal Experience
Friend or Relative
Other
24
As an authorized owner or agent of the above pet, I have read and understand the regulations above. While boarding at the South Shores Pet Clinical, I give the right to treat the above pet as they feel necessary for any medical problems that may arise. I understand that I accept full financial responsibility for any treatment that need be given. I agree to pay additional fees for optional services listed above. I understand that admission and discharge of my pet will occur during regular hospital hours.
Please check this box and type your full name in the box below to indicate that you agree to the terms above.
25
Owner or Authorized Agent* This field is required.
Clear
26
Date
Date
Year
Month
Day
Should be Empty: