Crossroads Veterinary Hospital

Crossroads Veterinary Hospital
Boarding Admission Form
We are glad to have your pet boarding with us!!! We will treat him/her as our own, giving a lot of love and attention, walks, comfy bedding, and medication if necessary. Here are just a few questions that we have for you!!!
Drop off after 12p will be a half days charge, any time before 12p results in a full days charge* *Pick up before 12p will be a half days charge, any time after 12p will result in a full days charge*
Personal Info
Owner Name:*
Patient Name:*
Phone Number:*
Admission
Date:

MonthDayYear
Date
Time:
Discharge
Date

MonthDayYear
Date
Date:
Time:
Emergency Contact
Name:
Number:
Feeding Information
Do you have your own food?
How much should we feed your pet?
How often?
Treats?

Medications (Please list name, amount given, how often, below)

	Name	Amount given	How often
1
2
3
4

Personal Items (please list below all items brought to us)
Item (1)
Item (2)
Item (3)
Item (4)
Medical Diagnoses (example: Arthritis, Coughing, Anxiety, etc.??)
Additional Services (Please check the additional services you want to include)

Bath ( Includes nail trim, ear cleaning, anal gland expression, and brush)Nail TrimAnal Gland ExpressionComplementary bath with stay of 5 full days or longer (BATH ONLY)
**Please ask receptionist for pricing**
If your pet is exhibiting anxiety during its boarding stay, we may at the doctor’s discretion, give anti anxiety medication, at your cost, to keep your pet stress free?
Initial
Is your pet up to date on vaccines? (If he/she has been vaccinated elsewhere, please provide proof of vaccinations). We DO recommend that vaccines are up to date at least 10-14 days prior to boarding. If he/she is not up to date on the following vaccines, at your cost, we will perform an exam and give the required vaccines for the boarding stay.
Initial
Dogs: Da2pp, Bordetella, Rabies
(Influenza is strongly recommended, but not required)
Cats: FVRCP, Rabies
Is your pet treated monthly with a flea/tick preventative?
Name of preventative

YesNo
Name of preventative
Last date preventative was given

MonthDayYear
Date
If you currently do not use a preventative, and your pet has fleas, we will give an oral tablet that kills fleas within hours, as well as administer a monthly flea/tick medication, at your cost, in order to protect our other patients.
Initial
Any other special instructions?
In the event of a medical emergency, I give the doctors at Crossroads Veterinary Hospital permission to medically treat my pet if they deem it necessary to do so. I understand that I will be responsible for all medical expenses that incur, upon my return.
Print first and last name:
Owner Signature :
Date:

MonthDayYear
Date
Should be Empty:

Personal Info

Feeding Information