First & Last Name * Pet Name * Species * Breed * Pet Age * Check-in Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Check-out Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Time of Pickup * Emergency Contact Number * Medications If applicable, please list medications with instructions and start date. Feeding Instructions Medical Issues Does the patient need to be seen by a doctor? If so, please explain. Date of Bord(k9) Vaccination Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Date of Dhpp/Fvrcp Vaccination Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Date of Rabies Vaccination Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Type of Rabies Vaccination One year Three year Vaccine Agreement * I understand that if vaccines are not current, they must be administered upon entry to our facility. Yes, I understand. Bordatella & Canine Influenza Agreement * For dogs, the bordetella and canine influenza vaccine can protect against the most common causes of kennel cough and canine influenza. If my dog’s bordetella vaccine or canine influenza vaccine has not been given at least 2 weeks prior to boarding today, there may be a risk of contracting kennel cough or canine influenza. I understand that I will be financially responsible for the cost of treating patient if this occurs. Yes, I understand. Grooming Services All dogs will receive a complimentary bath before going home if they stay overnight. Full grooming services are available for an additional cost pending availability. Would you like for your pet to be groomed while boarding with us? Yes No Stress Aids Does your dog or cat get stressed while boarding? We are offering a thunder shirt for your dog or feliway wipes for your cat. Yes No Leash Agreement I give Hillcrest Animal Hospital permission to allow my pet off leash in our outdoor fenced enclosure with supervision for play time/potty relief. Yes No Facebook Pictures Is it okay to put pet's picture on Facebook? Yes No Liability * I release Hillcrest Animal Hospital, employees, and associates from any liability of loss or injury. Yes, I agree. Medical Emergency * If any medical issues should arise, I hereby give the Doctors employed by Hillcrest Animal Hospital permission to examine my pet. If we are UNABLE to reach you, and your pet is URGENTLY sick, what is the maximum budget amount to treat your pet? Pet's Personal Belongings
