Boarding ConsentClient InformationName(Required) First Last Cell Phone(Required)Home PhoneEmail(Required) Patient InformationPet Name(Required)Breed(Required)Color(Required)Sex(Required)Age(Required)Weight(Required)Vaccine HistoryMy pet was vaccinated at(Required)In order to protect my pet and others, external parasites such as fleas or ticks will be treated on entry. I understand that my pet must also be up to date on vaccinations and have an in-date fecal exam.FVRCP (Cat)FeLV (Cat)Rabies (Dog)DHLPP (Dog)Bordetella (Dog)Fecal ExamFlea/Tick Prevention and Date GivenHeartworm Prevention and Date GivenCare InstructionsDiet, Amount and Frequency Fed(Required)* Food can be provided upon request, however keeping your pet on their regular diet is important to maintain GI health during their stay with us.List ALL Medication(s), Dose and FrequencyMy pet can have a blanket Yes NoOff Leash Yard Time Yes, I want my pet to run in the yard No, I would prefer my pet to be leash walked onlyList and Describe All Toys and PossessionsIf your pet is staying for more than one night, he/she will likely get soiled, and so we recommend a bath. I do want my pet bathed I do not want my pet bathedNail Trimming Preference I do want my pet’s nails trimmed before going home I do not want my pet’s nails trimmed before going homeI would also like for my pet to have the following services performed while boarding. (The price of this services will be discussed at the time of drop-off.)Emergency ContactBoarding drop off/pick up times are: Monday – Friday between 8:00am – 5:00pm & Select Saturdays from 7:30am – 11:30am. There are NO Sunday drop off or pick up hours. If you are planning on your pet to have a bath or procedure the day of pick up, plan to pick up AFTER 2pm so the pet is dry and any procedures are complete.Emergency Contact NameEmergency Contact PhoneAuthorizationI have verified that my contact information is complete and accurate. I understand that the employees of SRAH, PLLC will attempt to contact me in the case of an emergency. However, if I cannot be reached, I understand that my pet will be treated I am the owner (or authorized agent of the owner) of the animal described above, and have the authority to execute this consent. The fees associated with these services have been explained to me, and I agree to pay such fees at the time these services are completed.Date(Required) MM slash DD slash YYYY Signature(Required)CAPTCHAΔ
