South Putnam Animal Hospital - Cat Boarding Form

Welcome to the "Meow-iott" at South Putnam Animal Hospital
Owner's Name*

First NameLast Name
Cat's Name*
Admission Date*

MonthDayYear
Date
Pick-Up Date*

MonthDayYear
Date
Please Select One*

Cat BoardingCat Medical Boarding
Number where you will be reachable during your cat's stay*
Please enter a valid phone number.
Additional number(s) where you will be reachable during your cat's stay
Vaccines Required
Date of last physical exam*
Date of last Rabies vaccine*
Date of last Distemper vaccine*
Where were vaccines given (name + phone #)*
Flea Treatment:

To provide the best possible care for all of our boarders, each pet admitted to the hospital will be examined for fleas and flea dirt. Each pet exhibiting evidence of fleas will need to be treated while here.
Is your pet currently on medications?*

YesNo
Please write the type of medication(s) given and the dosage/qty*
Diet to be fed

Please note if your pet is on a prescription diet for health reasons, we may ask you to provide food if it is not a diet we have in stock.
Brand of Food:*
Amount Fed:*
How Often:*
Special Behaviors

Please note if your cat has any habits/needs that we should be aware of to best care for him/her.
Special Behaviors?
Please be aware that we may need to adjust your cat's medication and/or diet based on his/her needs while boarding with us.
Hospital Policies
It is the policy of our hospital to require a minimum deposit of 50% of the boarding fee for your cat’s stay. Please leave this payment with the receptionist when signing your pet into the hospital. Amount of Deposit $:
Your Initials and Amount of Deposit:*
I understand that if a medical problem is discovered, South Putnam Animal Hospital will telephone me or my emergency contact to discuss the problem and determine the course of necessary steps to diagnose and treat in accordance with current medical standards. In an emergency situation, measures to preserve and stabilize vital function shall be taken immediately without first contacting me or my emergency contact.
Your Initials:*
Occasionally, pets will vomit or not eat well, or have diarrhea while boarding with us. This may be due to the stress of being away from home. When this happens, we offer several different types of food to try to entice them to eat. Sometimes we need to give pets an appetite stimulant, medication for nausea or diarrhea, or fluids under the skin to help them feel better. In the event that my pet becomes sick while boarding, I give permission to have him/her treated at the discretion of the veterinarian, up to a cost $100.
Your Initials:*
You are to use all reasonable precaution against injury, escape, or death of my pet. The hospital and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed.. By signing this contract, I am stating that I am the owner of the above pet or their authorized agent and guarantee that I have the authority to sign this contract and am personally liable for expenses for lodging, veterinary services, and any other fees incurred while my pet is boarded. I UNDERSTAND THAT ALL CHARGES ARE DUE AND PAYABLE UPON DISCHARGE OF MY PET. I ACKNOWLEDGE THAT I AM OVER 18 YEARS OF AGE.
Signature*

Clear
Do you have an authorized person other than owner/agent listed to pick up pet?*

YesNo
Name of Authorized Person*

First NameLast Name
Signature of Authorized Person*

Clear
Should be Empty:

Welcome to the "Meow-iott" at South Putnam Animal Hospital

Vaccines Required

Flea Treatment:

Diet to be fed

Special Behaviors

Hospital Policies