Client/ Patient Information
Owner's Full Name:
Is your pet on heartworm preventative?
Is your pet on flea/tick preventative?
Any vomiting, coughing, sneezing or diarrhea?
Does your pet have any allergies? (Food or drugs)
Is your pet on daily medications?
Optional Services:
Dismissal Bath?
Nail trim?
Extra Playtime?
Name and Phone number for responsible party to be reached in an Emergency:
Owner Release

I understand you CANNOT guarantee the health of my pet. I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limite to weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea, and fleas. I understand ALL pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owners expense.

I understand that in the even of my pet’s illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options, but may not be able to contact me immediately and is therefor authorized to initiate appropriate treatment until me or my agent is reached.

If any problem is observed or develops: (Check one)
Sign above