"*" indicates required fields **Attention: All pets MUST be current on all vaccines and Flea/Tick prevention to be boarded at our hospital** Client Name Patient Name PreventionsIs your pet on flea & tick prevention?* Yes No What brand?* When was it applied/given?* DietKennel Food (GI) Owner Provided Food Food Name Medications(There will be an additional $5 charge per day for giving medications.)Medication NameDoseHow many times per day?Refill? Add RemoveWhat time of day were the medications last given? MiscellaneousDo you have any concerns that you would like the doctor to address during their stay?* Yes No (There will be a charge for an examination fee)Concerns*During your pet's stay would you like to receive pictures?* Yes No Email* Are you leaving any personal items with today?* Yes No (Please keep in mind that some items may be lost or damaged during your pet's stay)Item's Description*Do your pets have a history of eating blankets and/or towels?* Yes No Boarding Add OnsPlease check to approve the following add ons during your pet's stay: Anxiety Medications ($3/day) *IF NEEDED* Diarrhea Medications ($25-40) *IF NEEDED* Bath with Nail Trim ($25-65) Nail Dremel ($20-30) Snuggle Time with Kennel Staff (1xDay = $10; 2xDay = $18) Play Time with Kennel Staff (1xDay = $10; 2xDay = $18) Leash Walk with Kennel Staff (1xDay = $10; 2xDay = $18) Snuggle Time*Time per DayHow Many Days___ x Day for ___ DaysPlay Time*Time per DayHow Many Days___ x Day for ___ DaysLeash Walk*Time per DayHow Many Days___ x Day for ___ DaysIn case of EmergencyI consent to the treatment of my pets in the event of an emergency InitialsEmergency Phone Number NOTE: In the event, we are unable to reach you, the veterinarian on staff will treat the patient at their discretion. Boarding will be charged based on the number of nights your pets are here. Cost is based on the type of reservation along with any add ons that were requested at the time of drop off.* I agree All dogs will be walked three times a day (if applicable), fed twice daily and have a clean and comfortable space.* I agree Pick up is Monday-Friday 8am-5pm or Saturday 8am-11am.* I agree Saturday evening or Sunday pickup is NOT available* I agree Signature*Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.