Canine Boarding Form
Current DHLPP, Kennel Cough, and Rabies vaccinations are required for all dogs. If your pet has not been vaccinated at Hermann Veterinary Clinic, proof of vaccination is required and if proof is unavailable, your pet is required to have their vaccinations updated when they arrive for their stay.
Name
*
First Name
Last Name
Phone Number you can be reached while your pet is boarded
*
Please enter a valid phone number.
Email
*
example@example.com
Pet Name
*
Arrival Date
*
-
Month
-
Day
Year
Date
Departure Date
*
-
Month
-
Day
Year
Date
Can Pets Board Together? (If you are boarding multiple pets)
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Yes
No
N/A
Food
Diet: Hills Science Diet Adult food is fed to all boarders unless we are otherwise instructed. Special diets must be supplied by the owner.
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I would like my pet fed the premium diet Hermann Vet Clinic feeds their boarding pets
I would like my pet fed the diet I provided
I would like to purchase a special diet for my pet
Food provided (name/brand of food)
Dry Food Amount
Times Per Day
Once per day
Twice per day
Other
Canned Food Amount
Times Per Day
Once per day
Twice per day
Other
My pet was last fed:
Indicate when your pet will last be fed by you prior to drop off.
Medication
Does your pet require medication while boarding with us?
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Yes
No
Medication #1 name and strength
Example: Rimadyl 75mg
Times Per Day
Once per day
Twice per day
Other
Medication #1 notes (e.g. times of day normally given, how you give it (e.g. in peanut butter, pill pocket, etc).
Have additional medications?
Yes
No
Medication #2 name and strength
Example: Rimadyl 75mg
Times Per Day
Once per day
Twice per day
Other
Medication #2 notes (e.g. times of day normally given, how you give it (e.g. in peanut butter, pill pocket, etc).
Have additional medications?
Yes
No
Medication #3 name and strength
Example: Rimadyl 75mg
Times Per Day
Once per day
Twice per day
Other
Medication #3 notes (e.g. times of day normally given, how you give it (e.g. in peanut butter, pill pocket, etc).
Additional Services
Does your pet need additional services (e.g. doctor exam, grooming, etc) while staying with us?
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Doctor exam
Grooming
Please explain the reason for the doctor examination and any specific questions or concerns. Be sure to include any relevant history (e.g. how long symptoms have been going on, any medication you have administered, etc).
Please complete the grooming form (link provided at completion of this form).
Consent for Medical Treatment
Although Hermann Vet Clinic provides the safest boarding environment possible, medical emergencies and/or unforeseen problems can arise. If your pet develops any problems, we will make every effort to contact you, or your emergency contact, immediately. In the event that we cannot reach a family member or friend, we would like your permission to provide essential care.In the event that my pet develops any medical problem during its stay at Hermann Vet Clinic, I authorize essential medical or surgical treatment up to $___________, until I can be reached. I will assume full financial responsibility for any medical treatment provided.
*
Please indicate $ amount to be spent on essential treatment until you can be reached
Emergency contact number:
*
If I cannot be reached, please contact:
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First Name
Last Name
Relationship
Authorized representative/Emergency contact phone number
*
Please enter a valid phone number.
This person is: ____________________ to make medical decisions on behalf of my pet
*
Authorized
Not authorized
Name of authorized individuals who can pick up your pet if you are unable to do so:
*
First Name
Last Name
Final Signature Authorization
Signature to authorize this information
*
Submit
Should be Empty: