BOARDING QUESTIONNAIRE

BOARDING QUESTIONNAIRE
This questionnaire also acts as a contract between The Drake Center and the Pet Owner
Pet name*
Pet age (senior pets and puppies/kittens will have an added fee)
Client name*
Arrival date*

MonthDayYear
Date
Departure date*

MonthDayYear
Date
Departure time* (by 12PM or 1/2 day charge will apply)*

Hour Minutes

AM/PM Option
Has your pet been eating, drinking, urinating, defecating and otherwise acting normally over the last week? Please note any changes noticed, even if subtle:
The Drake Center offers three diet options to fufill your pet's needs:
1. The Drake Diet: Canned or Dry Hill's Science Diet
2. Owner's Choice: Owner provides a kibble or canned diet of brand choice (No charge; the Drake Center encourages this if your pet has a sensitive stomach)
3. Speciality Diet: Owner provides an alternative diet with specialty handling and care. This includes home cooked meals and food additives. Meals must be prepared by client and in single serve packaged containers (This is a fee of $11 per day).
Please always provide extra food in case of spillage or trip delays.
While boarding what will your pet be eating?*

Drake in-house diet (Science Diet dry/wet food)Diet from home: Please specify below
(If diet from home) Please list brand of food/protein: ex: Science Diet Ideal Balance Chicken dry food)
What type of food does your pet eat?*

DryWetBothOther
How much is your pet fed per meal?*
How often is your pet fed per day?*

1x2x3xOther
When was your pet last fed?*

MonthDayYear
Date
Time pet was last fed?*

Hour Minutes

AM/PM Option
If your pet were to run out of food while boarding, could we feed your pet our in-house diet?*

YesNo
Please list any medications your pet will need while boarding*. Describe the current dosage, duration and time last given. (ex: Rimadyl 100 mg - Give 1/2 tablet by mouth twice daily - last given at 8am on 5/5/19)
*Additional fees apply
Does your pet have any special needs? Please describe below
Would you like your pet to receive any additional services while he/she is boarding?*
Bathing* including nail trim and ear cleaning. Anal gland expression upon request (Dogs only)

Regular bathMedicated bath*Anal gland expression
Extra playtime*

DailyEvery other dayEvery three daysOther
Other services* (daily brushing, dental care, etc.)
*Additional fees apply
Is your dog friendly with other dogs?

YesNo
Would you like your dog to enjoy some time playing in the yard with other dogs of the same size and temperament?

YesNo
Will you have email access? If so, please provide email address:
example@example.com
Please list a telephone number where you may be reached:*
Would you like to receive photos of your pet and/or periodic text messages with updates on your pet? (Updates will be approximately every other day.)

Yes - TextsYes - PhotosNo
If yes, please list preferred phone number for text messages:
If we are unable to contact you, who should we contact to make pet care decisions on your behalf?
If not, The Drake Center for Veterinary Care will assume the role of emergency contact.
To protect our patients while boarding, we require all boarding pets to have a current examination by a Drake Center veterinarian (frequency based on the age and health of the pet), current vaccinations including DHP-P, Bordetella and Rabies for dogs, FVRCP and Rabies for cats, a current fecal examination and de-worming. All pets must also be free of external parasites (fleas and ticks).

In the unlikely event your pet should become ill or develop any medical condition requiring treatment, we will do our best to contact you and/or your emergency contact. It is our policy, however, to use our best judgement in providing medical care to the pets left in our care. By signing below, you acknowledge this policy and understand that you will be financially responsible for any fees accrued. Please note that this facility does not have an overnight attendant.

This boarding facility follows all guidelines established regarding abandonment laws and lien guidelines under the Civil Code 3080, 3051, 3052. A copy of the abandonment clause is posted in the reception area of our facility.
Signing this document acknowledges that I understand...
- The text above
- The daily boarding fees and charges and agree to pay the full amount, including extra charges applied for speciality diets
- The Drake Center is not responsible for any stress-related, pre-existing, or breed-related conditions of boarding pet
- The Drake Center is not responsible for any damage or loss to pet's carriers, toys, supplies, etc.
- That Kennel Cough has many strains and is an airborne virus which is unpreventable
Signature of Client*

Clear
Date*

MonthDayYear
Date
Should be Empty:

BOARDING QUESTIONNAIRE

This questionnaire also acts as a contract between The Drake Center and the Pet Owner