Medical Boarding Admission Medical Boarding Admission Form Pet Name * Client # * Admitted by Arrival Date * Departure Date * Rate Note: On date of departure please call ahead with approx. pick up time to facilitate speedy release. Boarders stayingmore than 5 days receive a complimentary bath prior to departure. Primary Contact Name * Primary Contact Name First First Last Last Phone * Email * Secondary Contact Name Secondary Contact Name First First Last Last Secondary Contact Phone Secondary Contact Email ALL ANIMALS ADMITTED MUST BE CURRENT ON THEIR ANNUAL HEALTHY EXAM, VACCINATIONS, MUST BE FREE OF PARASITES AND ON CURRENT FLEA AND TICK PREVENTIVE. PROOF OF VACCINATION MUST BE PROVIDED OR VACCINATIONS WILL BE ADMINISTERED BY ONE OF OUR STAFF AT THE OWNERS EXPENSE. Dog Vaccinations Required: DHPP(Distemper), Rabies, Bordetella Cat Vaccinations Required: FVRCP(Distemper), Rabies Are you using Flea/Tick preventative? * Yes No Any Animal found to have fleas or ticks will be treated at the owners expense. Date of last application List all Medications, Vitamins, Supplements Your Pet Takes Dosage Frequency Given today plus1 Add another minus1 Remove one Feeding Schedule Wet Dry Misc Amount/ Frequency of Feeding Food Given Today Owner Provided Food * Yes No If needed the hospital will provide Science Diet Dry Food Free of Charge. If prescription food is needed it will be at the owners expense. Accessories *Please be aware we cannot be responsible for items damaged or lost during your pet’s stay THINGS WE NEED TO KNOW (Fears, Stressors, Behavior Issues, Allergies etc..) * If your pet becomes ill or injured while boarding at BVH, every effort will be made to reach you through the emergency contact information you provided. If you cannot be reached in a timely manner, your pet will be treated at the discretion of our medical staff. All expenses incurred for this treatment will be your responsibility. Owner/Representative Signature * signature keyboard Clear Date * Captcha Submit If you are human, leave this field blank.
