Toro Park Animal Hospital Boarding Intake Form

Boarding Admission Form
Owner's Name*

First NameLast Name
Pet's Name
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Drop-Off Date

MonthDayYear
Date
Drop-Off Time (AM/PM)
Pick-Up Date

MonthDayYear
Date
Pick-Up Time (AM/PM)
Secondary Emergency Contact

First NameLast Name
Secondary Emergency Contact Phone Number
Please enter a valid phone number.
Does your pet have a history of digging at or jumping fences? Any special behavioral/aggression issues? Please describe.
For an additional cost we can walk your dog or give your cat extra play time; If yes, how often?
Personal items my pet brought today:
Feeding - Diet, Amount To Feed, How Many Times A Day
Medications - Directions, Last Given, How Many Times A Day
Flea Prevention - Last Applied On, Product Used (If flea control is not current or if fleas are seen on your pet while boarding, we will treat your pet for fleas to avoid discomfort to your pet and to preventthe spread of infectious disease in our facility.)
Infectious Disease Control: To prevent infectious disease spread and protect all boarders, all patients must have a current annual exam, have been dewormed within the last yearand be up to date on required vaccines. I authorize this level of preventative care and accept full financial responsibility for these services. Please Initial Below.
My pet is due for (An estimate will be given by phone prior to treatment during boarding).

ExamVaccinesLab WorkRX RefiilsNail TrimAnal Sac ExpressionOther
In the event that I am not available by phone, I hereby authorize TPAH to perform such diagnostic/therapeutic as are deemed necessary to protect mypet’s health and well-being. I accept that all procedures will be performed to the best of the abilities of the DVM on site. I understand that there is noguarantee that treatments will be successful. I assume full financial responsibility for the services performed. Please initial below.
Signature

Clear
Today's Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Boarding Admission Form