Companion Animal Hospital Boarding Check In Form

PATIENT NAME

OWNERS NAME

First Name Last Name

DROP OFF DATE

Date

PICK UP DATE

Date

SPECIES

DESCRIPTION

I understand that my pet must be current on all vaccinations required by CAH prior to boarding. If proof of vaccines is not presented at the time of boarding, the vaccines will be given and I will be charged for these services. If parasites are found they will be treated while boarding.

If my pet becomes ill or an emergency arises, I understand Companion Animal Hospital will perform diagnostics and treatment medically necessary for the health and comfort of my pet during their boarding. We will attempt to contact you, but if we are unable to reach you, we will still treat your animal.

DOG OWNERS

Current on all required vaccines? (Rabies, Distemper, Bordetella)

Yes No

Needs: Check any services needed

CAT OWNERS

Current on all required vaccines?(Rabies, FVRCP)

Yes No

Needs: Check any services needed

Exam Rabies FVRCP Bordetella Leukemia Fecal TNT Potty Patch Bath

MEDICATIONS

FOOD

ITEMS BROUGHT

PLEASE BE AWARE OF THESE PROBLEMS

***IN AN EMERGENCY PLEASE CALL***

Name

Phone Number

Area Code Phone Number

Name

Signature

Clear

Date