Boarding Registration Form

4020 South Babcock Street Melbourne FL 32901

321-727-2421
Boarding Registration Form
Owner
Pet's Name
How can we reach someone in case of an emergency?

Phone CallEmailOk to text?
Phone Number
E mail Address
example@example.com
Note: we do not feed raw diets in the hospital
Food type and feeding schedule
If you are bringing your own food, please specify what brand:

YesNo
Brand of food
Any food allergies?

YesNo
Does your pet require any regular medication while boarding?

YesNo
If yes, list medication and schedule:
We do not accept any personal items other than food and medication.

Note: we do not feed raw diets in the hospital
Does your pet need any services other than boarding during his/her stay? Please describe:
Planned Pickup Day

MonthDayYear
Date
Time
Please check

AMPM
Do you want your pet to have a bath before it goes home (extra charges apply)?

YesNo
Do we have permission to use photos taken of your pet on-line, while boarding?

YesNo
In the event of an emergency medical condition, I hereby authorize the doctors and staff of Animal Medical Clinic to administer, at my expense, any medication, tests, anesthetics or surgical procedures that the doctor deems necessary for the health, safety or well being of my pet. I understand that at times, my pet will be left in the building without supervision.
Should be Empty: