Harris Hill Animal Hospital Boarding Form

Boarding Admission Form

Date:

Date

Pet Name:

Your Pet's Name

Owner's Name:

First NameLast Name

Boarding Information:

Drop-Off Date:

Date

Drop-Off Time:

Pick-Up Date:

Date

Pick-Up Time:

For your pet's health and others in our care, we require vaccines and deworming to be current. Please provide appropriate records if given elsewhere. All dogs will be given a complimentary bath after 3 days of boarding.

YesNo

If live fleas/ticks are seen on your pet, flea/tick control will be applied at the expense of the owner.

We provide bedding and bowls. If you wish to bring bedding from home, realize that it may be damaged/soiled by your pet. Bedding may get lost during laundering. We are not responsible for lost or damaged personal items.

For our canine boarders: During your dog's stay, he/she will be walked outside for elimination and exercise. Dogs are taken outside several times each day.

I,[name] acknowledge that there are inherent risks associated with this, and would like my dog to be walked outside.

Feeding Instructions:

We feed a prescription diet which is specially formulated to reduce stomach upset caused by an abrupt diet change. You may purchase another diet or bring something from home if you wish.

Brand provided by Harris Hill Animal HospitalBrand provided by owner

If providing own food, please list brand here:

MorningNoonNight

Amount at each feeding:

Special Feeding Instructions:

Medications:

Please list all medication you would like us to administer, the amount given, frequency, and time of last dose. Additional fees to administer will apply.

Rows	Name of Medication	Time of Last Dose	Amount to Give	Frequency
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6

Social Media:

Within the context of promoting our business and pet health, we would like to use images, videos, and/or information about your pet on our social media sites.

YesNo

Emergency Contact/Authorization Information:

If your pet develops minor ailments while in our care, every attempt will be made to reach the owner or guardian. If unable to reach an owner or guardian, and your pet is in need of urgent or emergent care, our Doctors and staff will perform diagnostics, medical and/or surgical procedures or treatments to preserve the life or comfort of your pet. You accept the financial responsibilities for such care. We do not guarantee a successful outcome.

By signing below, you accept financial responsibility for diagnostic work-up and/or treatment as recommended by the veterinarian in the event that urgent/emergent care is needed.

Phone Number where you can be reached:

Please enter a valid phone number.Format: (000) 000-0000.

Alternate Contact:

Alternate Contact's Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Signature: