Pittsford Animal Medical Boarding Check-In Form

Medical Boarding Check-In Form
Did you call to make your pet’s reservation?

Please arrive before 2pm when bringing your pet in for medical boarding so our team can review your pet’s boarding needs.

If boarding more than one pet, please fill out this form for EACH pet.

Medical Boarding Pick-up hours:
Monday-Thursday 7:30 a.m.-6:30 p.m.
Friday 7:30 a.m.- 4:30 p.m.
Saturday 8 a.m.-1:30 p.m.
Sunday CLOSED No Pick-up
Owner's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Species
Approximate Weight
Regular Veterinarian
Arrival and Departure

We require pets to arrive before 2pm for Medical Boarding.
Arrival Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Departure Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I will pick my pet up:
Authorized Persons

We will not release the pet to anyone other than the owner without prior consent. All pets must be picked up within 5 days of the specified check-out date. All efforts will be made to contact the owner/agent. Failure to respond or pick up a pet will result in the facility protocol for abandoned animals.
Name and Number of Authorized Person
Name and Number of Authorized Person
Name and Number of Authorized Person
Your pet’s RABIES VACCINATION MUST BE CURRENT for medical boarding. If you pet requires a rabies vaccination, an exam will be required. Please select from the below:
Brief Description of your Pets Medical Condition and Needs:
Is there anything you would like our team to check while your pet is boarding? (Exam and other fees may apply.)
Please read and check below if your pet is a diabetic boarder:
Medications
Medication Name:
Time(s) Medication Given (i.e. 8am and 5pm):
Please enter a valid phone number.Format: (000) 000-0000.
Dose/Units Given:
Please enter a valid phone number.Format: (000) 000-0000.
Date/Time Medication will be Last Given on Arrival Date:
Please enter a valid phone number.Format: (000) 000-0000.
Special Instructions for giving medication:
(ie, takes with peanut butter, pill pockets, wet food)
Add another medication?
Feeding
Appetite
Time(s) Your Pet is Fed (i.e. 8am and 5pm):
Amount Per Feeding
Any Special Feeding Instructions
If my pet becomes ill and requires medical or surgical treatment, I give my permission to examine and treat as indicated below:
Please read and check that you agree to the following:
Please read and check that you agree to the following:
Please read and check that you agree to the following:
Please read and check that you agree to the following:
Signature
Should be Empty:

Medical Boarding Check-In Form

Did you call to make your pet’s reservation?

Arrival and Departure

Authorized Persons