| Pet’s Name________________________ Owner’s Name______________________ Drop Off Date________Pick Up Date_________AM/PM Bath/Groom_________ Would you like any treatments done to pet(i.e., vaccinations, nail trim, exam, anal glands expressed)?________________________________________________ Feeding Instructions___________________________________________________ Special Instructions(meds to give, etc.)____________________________________ ____________________________________________________________________ Items brought in with pet_______________________________________________ ____________________________________________________________________ Please specify the area in which you would like your pet boarded (check 1 box): |
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| Dogs: | Cats: |
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Would you like your pet to receive either of these special boarding options? (check box): |
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| OWNER RELEASE |
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Perform only emergency and supportive care. Notify me for permission to begin any other treatment. Do NOT perform any diagnostics and/or treatment until I am notified and consent for you to evaluate and treat as recommended. |
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Date:_________________ |
Owner/Agent:____________________________________________ |
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Name & Phone # of Responsible Party to be Reached in Emergency: |
________________________________________________________________ |