Boarding Intake Form

Name: Veterinarian
Brand: Park Animal Hospital

Dates of Boarding

Drop Off Date

Pick Up Date

Client Information

First Name

Last Name

Pet Information

First Pet's Name

Second Pet's Name

Third Pet's Name

Fourth Pet's Name

Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

Is Your Pet Current On Vaccines?

Yes

We require all pets who board with us to be current on vaccines and that PROOF is provided. If your pet is not current on vaccines, they must be updated by us to board.

Feeding

I Brought My Own Food

I Will Use Food Provided By Park (Ivet Maintenance)

Food Frequency:

Please describe the amount and how often you would like us to feed your pet.

**There is a $5.00 per day fee to medicate your pet during their stay**

Name Of Medication

Amount

Frequency

Next Dose Due

We provide blankets and bedding for your pet during their stay with us. Due to the frequency we change bedding, PLEASE DO NOT bring any blankets or bedding for your pet.

Please list a detailed and descriptive note of the personal items you have brought for your pet:

Would you like any other services or procedures during your pet’s stay with us such as: GROOMING, NAIL TRIM OR DENTAL?

I hereby consent to necessary symptomatic medial treatment for my pet(s). This may include but not limited to diarrhea, vomiting, etc. This will include the cost of an exam and treatment as discussed with the doctor

I Agree

I understand that Park Animal Hospital does not have overnight staff

I Agree

In the event of an emergency situation I authorize the doctors to perform the necessary medical procedures. I understand an effort to contact me will be made at the emergency number provided on this form.

I Agree

I agree to accept financial responsibility for charges incurred during my pet’s stay

I Agree

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Boarding Intake Form

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