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:*
YESNO
YESNOIF NEEDED
YESNO
YESNO
List any medicines and frequency to be given while boarding:*
YESNO
If so, which medications are still needed and when (AM or PM)? *
Kennel food(Sensitive Stomach)Own foodPrescription Diet
Own food - Brand:*
Prescription Diet:*
Amount and frequency of meals: *
YESNO
AMPM
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 :
Treat as neededCall prior to treating
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:*

Clear
Date:*

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

Boarding Consent Form