ELMBROOK VETERINARY CLINIC BOARDING FORM
Animal Name: _______________ Canine Feline Other:_____________
(one form per animal please) Please Circle
Check in Date: ___/____/____ Check Out Date ____/____/____
Emergency Contact: _____________________ Phone number:____________________________
Alternate Contact : _____________________ Phone number:____________________________
PET HEALTH HISTORY:
All pets being boarded must be clients of the Elmbrook Veterinary Clinic (“Clinic”) and current on a yearly exam and all vaccines, including bordetella. If not, the Clinic will do said exam and vaccinations during the duration of the animal’s boarding.
I give permission for the following veterinary care: _______________________________________________________________________________
IN THE EVENT OF AN EMERGENCY EVENT AND THE NEED FOR IMMEDIATE ACTION….
I give permission for any necessary treatment _____ with costs not to exceed $________ (recommend $300)
I do not give permission to treat ____ (initials)
Does your pet have any chronic or known health concerns?________________________________________________
What kind of food?
How much should we feed your pet?
How many times per day?
How often and with or w/o food?
Please list personal items pet will have while boarding with us:
Pets are fed twice per day. Fresh water is available at all times and we provide bedding and bowls. We ask that you not provide blankets. You can provide toys and treats!
Pet signed in by:____________________ Owner signature:__________________________