villagevethouston.com - Regular Boarding Form

Boarding Consent Form

Village Veterinary Form
Date

MonthDayYear
Date
Client Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:
Please enter a valid phone number.Format: (000) 000-0000.
Pet's Name:
Age:
Sex:
Breed:
Drop off date:

MonthDayYear
Date
Pick up date and time:

MonthDayYear
Date
Hour MinutesAM/PM Option
Emergency Contact Name:
Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Relationship:
Would you like your pet to be bathed on the day of discharge? *If yes, plan pick up after 1pm
Flea Treatment?
Does your pet suffer from noise adversities, such as thunderstorms? *If yes, for the comfort and security of your pet, we may medicate if the veterinarian feels it's necessary.
Has your pet ever been known to chew on, eat, or ingest bedding, blankets, or towels?
List any medicines and frequency to be given while boarding:
Does your pet still need any medications today?
If so, which medications are still needed and when (AM or PM)?
Diet while boarding:
Own food - Brand:
Prescription Diet:
Amount and frequency of meals:
Does your pet need to be fed today?
Additional needs:
All boarders must be current on all vaccinations and free of extemal parasites (ex. ticks, fleas, etc.). Village Veterinary Clinic will provide medical treatment (including vaccinations and/parasite treatment) deemed necessary for my pet while in their care. I understand there will be additional charges for treatments or any special requests needed beyond routine boarding (including any required prescription diets).
In the event of an illness or medical emergency, I authorize Village Veterinary Clinic to treat Your pets name :
Select one:
I have read the boarding requirements and understand the hospital's policies and acknowledge that Village Veterinary Clinic does not have overnight staff or a fire suppression system.
Signature of Owner or Agent:
Date:

MonthDayYear
Date
Items brought from home:
VVC is not responsible for lost items
Should be Empty:

Boarding Consent Form