<<< BOARDING ADMISSION FORM <<<

<<<<<<<<<<<<<<<<< PLEASE READ CAREFULLY BEFORE SIGNING <<<<<<<<<<<<<<<<<<<<<<

** WE WILL NOT BE RESPONSIBLE FOR ITEMS LEFT ** (toys, bedding, leashes etc)

 Client:_____________________________________________________________________

 Patient(s):__________________________________________________________.

 Emergency Phone:____________________Contact:_____________Date:________

 Emergency Phone:____________________Contact:_____________Date:________

 Emergency Phone:____________________Contact:_____________Date:________

 *** WE ASK THAT YOU NOTIFY US OF ANY CHANGE IN EMERGENCY NUMBERS AT EACH BOARDING ADMISSION. ****

We pride ourselves on our ability to offer you a clean boarding facility free of external parasites, but because this is a hospital, some of our patients are not able to handle insecticides due to medical conditions. For this reason we recommend that all pets be treated with Frontline or Advantage. Feel free to discuss these products with any staff member. ________ (Initials)

I understand that all pets entering the hospital must be current on all required vaccinations, and free from external and internal parasites, or they will be treated upon entry at my expense. __________ (Initials)

CANINE VACCINATIONS INCLUDE: Distemper, Parvo, Rabies, Kennel Cough, Corona

FELINE VACCINATIONS INCLUDE: Feline Distemper, Rabies

I also authorize Dr. Woods, and whomever he designates as an associate or assistant, to perform whatever services he deems necessary should an emergency or illness arise. _________ (Initials)

I understand that payment for all services is required when pets are released. _______ (Initials)

I am aware that pets are to be released only during business hours. If I neglect to pick up my pet(s) within 5 days of the release date, Memorial Road Pet Hospital staff will assume that my pet(s) have been abandoned, and is authorized to dispose of my pet(s) as deemed best. ________ (Initials)

Medications (Given as directed in writing or as labeled) for the additional fee $3.90 per day. If three or more medications are needed the fee will be $7.80 per day. ______(Initials)

Special Diets: Must have written instructions and labeled with pet’s name. ______ (Initials)

Puppies/Extra Care Patients: Pets under one year old or patients that require extra care may be charged and additional fee of $6.50 per night. _____(Initials)

I agree to the terms listed above:

 Signature: __________________________________________________________________.