Owner Information
Owner's Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
Format: (000) 000-0000.
Emergency Contact Number (Please make sure you will be available at emergency number given or will be checking messages regularly).
*
Dates Of Stay
Arrival Date
*
-
Month
-
Day
Year
Date
Departure Date
*
-
Month
-
Day
Year
Date
Pet Information
Pet Name
*
Prescription Medications, Over The Counter Medications, Supplements, and/or Vitamins: Please provide us with clear instructions including the name, dosage, and directions. (Note: There is an additional charge for administrating medications.)
*
Feeding Instructions: Please provide us with detailed instructions regarding your dog's feeding schedule, portion sizes, and any specific dietary restrictions.(Note: Owners must provide food - We recommend using small plastic baggies to package pre-measured meals with your pet's name on it.)
*
Belongings: I understand that Skippack Animal Hospital is not responsible for lost or damaged belongings. (Note: We do not allow owners to provide beds or blankets)
*
I understand
Would you like your pet to receive any additional services?
*
15 Minute Playtime
30 Minute Playtime
Extra Walk
Peanut Butter Kong
15 Minute Cuddle Time
Doggie Day Camp
None
Other (For example, an appointment, nail trim, etc.)
How frequently would you like us to provide the additional services? For example, once a day? (Note: Pets may only get one extra service per day).
*
I am aware that if my pet is not up to date on all required vaccinations that my pet will be vaccinated at my expense.
*
Yes
Would you like your pet to receive a complementary bath? (For cooperative dogs only, staying 5 or more days).
*
Yes
No
If you pet experinces an emergency while staying with us, would you like to proceed with CPR and lifesaving treatments (Additional costs will be incurred).
*
Yes
No
Should your pet experience stress and anxiety while staying with us, do you permit us to administer medications to keep them calm?
*
Yes
No
If your pet develops a medical condition during their stay with us and we are unable to contact you, do you permit us to perform diagnostics and/or treat your pet. (Additional costs will be incurred).
*
Yes
No
Client Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: