Owner’s Name:
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Emergency Contact:
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Email: |
Check In Date:
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Time: |
Check Out Date:
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Time: |
| ***Sunday pick up time is between 3:00-5:00pm. There is an additional service charge of $______ per pet if you pick up on a Sunday. Initials: _______ |
1st Pet’s Name:
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Dog
Cat |
2nd Pet’s Name:
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Dog
Cat |
3rd Pet’s Name:
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Dog
Cat |
4th Pet’s Name:
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Dog
Cat |
5th Pet’s Name:
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Dog
Cat |
6th Pet’s Name:
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Dog
Cat |
Vaccinations Current / Due:
Current
Due - Initials: __________
Vaccinations Needed:
(Vaccines must be done prior to coming in)
Doctor Treatments Needed:
Medication/Food Refills:
Yes
No
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| Feeding Instructions |
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Kennel
Own Food |
Brand Name:
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Amount:
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How often do you feed?
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Do we need to entice with wet food?
Yes
No |
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Medications:
Yes
No
Have medications been giving today?
Yes
No
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Which Dose?
AM
PM
Both |
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| *There is a $0.65 treatment fee, per medication dosage given per day. Initials: _____ |
1st Medication:
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2nd Medication:
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3rd Medication:
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4th Medication:
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| Medication dosage changed per owner?
Yes
No Initials: ________ |
| Is there Luggage that is being left with patient?
Yes
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1st Luggage:
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2nd Luggage:
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3rd Luggage:
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4th Luggage:
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5th Luggage:
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6th Luggage:
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Playtime:
Yes
No |
Playtime Package Deal?
Yes
No |
Package Name: |
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Bath w/boarding:
Yes
No |
Groom w/Lisa:
Yes
No |
Scheduled Date:
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Special grooming instructions:
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Would you like Sugar Cookie applied to your pet at Check out:
Yes
No
*In the event that your pet (s) has an adverse reaction or a staff member observes anything abnormal during their stay with us, please allow our Doctors to provide the necessary care for your pet (s).
**I authorize Premier Animal Hospital to do what is in the best interest of my pet. (Owner will receive a courtesy call from a Doctor or Technician after the patient is treated.)
Other Amount $
. Initials: _______
**Please call before performing any procedures/treatments. However, if you are unreachable or will be out of phone service during your trip, we ask that you authorize Premier Animal Hospital to treat your pet (s) in the amount of:
Other Amount $
. Initials: _______
* If your pet is found to have fleas, capstar will be given at Owner’s expense. Initials: ________
*For our guest we will provide all bedding, bowls and dietary needs unless otherwise specified. Therefore we strongly discourage any personal items at the spa. In the event that you would still like to bring personal belongings, PPRDS will not be held responsible for any damaged or lost items.
**PPRDS will not be held liable for any unforeseen injuries to your pets that may occur when more then one pet are boarded together in one kennel. In the event that your pets need to be separated or need medical attention we will do whatever is deemed necessary for your pets safety & welfare at the owner’s expense. Initials: ________
**We do not recommend boarding puppies at PPRDS that are not fully vaccinated, as their immune systems are not fully developed. We take the utmost precautions to board them away from the main population. ****
***Aggressive dogs will be charged an additional $10.00 fee per night on top of the original boarding cost. ***** Initials: ________
***Check out is by 1:00pm, if not picked up, you will incur a Daycare fee of $______, and your pet will be placed into Daycare, where they will receive playtime and treats. Pick up time is before closing that day.***** |
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