Fairview Heights Animal Clinic - Boarding Request Form

Boarding Request Form
Submit this form to expedite the reservation process. A member of our boarding staff will call you to confirm availability shortly after your reservation request is submitted.
Owner Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
YesNo
What is the best time to reach you by phone?*
Pet Information
Pet's Name*
DogCat
YesNo
Approximate weight in pounds (if dog)
3x44x43x6Micro (for pets under 15 lbs, requiring a quiet space
Pet #2
Pet #2 Name
DogCat
YesNo
Approximate weight in pounds (if dog)
3x44x43x6Micro-for pets under 15 lbs requiring a quiet space
Pet #3
Pet #3 Name
DogCat
YesNo
Approximate weight in pounds (if dog)
3x44x43x6Micro-for pets under 15 lbs requiring a quiet space
YesNo
If yes, please describe (include medication name, dosage and frequency if applicable)*
YesNo
Requested Dates of Stay
Arrival Date*

MonthDayYear
Date
Departure Date*

MonthDayYear
Date
8am-12pm3pm-5pm
Additional Boarding Information
Pets are permitted 2-3 personal belongings such as bedding, blankets, or toys requiring no supervision.

Do not bring bowls as we will provide our own bowls for food and water for your pets as well as bedding.

Negative fecal test and up to date vaccines are required for all boarding pets, these charges will be added to your service if your pet is out of date.
Submitting this form does not guarantee a reservation. You must receive a phone call from a member of our staff to verify and confirm that your requested accommodations are available.

If you have not received a phone call from our staff within 48 hours of submitting this form, please call our office at (618) 398-1530 (Fairview).
Signature*
Today's Date*

MonthDayYear
Date
Should be Empty:

Boarding Request Form

Owner Information

Pet Information

Pet #2

Pet #3

Requested Dates of Stay

Additional Boarding Information