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?________________________________________________

Feeding Information

What kind of food?

How much should we feed your pet?

   How often?

Medication Information

Medication

How many times per day?

How often and with or w/o food?

Please list personal items pet will have while boarding with us:

Special Instructions:

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:__________________________