Date
Owner Name*
Street Address
City
State
Zip
Home Phone
Mobile Phone
Email
Pet's Name
Breed
Sex MaleFemale
Age
Color
Medications to be given while boarding. (Please list all, as well as times to be administered)*
* THERE IS A CHARGE FOR MEDICATIONS TO BE GIVEN WHILE YOUR ANIMAL IS BOARDING
Please list all services to be performed while your pet is boarding:
NOTE: All animals entering the hospital MUST be up to date on vaccinations and free of external parasites. (fleas, ticks, etc.), or they will be treated upon entry at the owner’s expense.
Instructions
Boarding can be stressful for some pets. Stress-related colitis can result from a change in environment, food, water as well as from noise from other pets. Should this occur, Montgomery Animal Hospital will conduct a stool sample analysis and prescribe a medication and/or special food while boarding.
If tranquilizer is necessary for treatment or handling, I give my permission for Montgomery Animal Hospital to administer such medication. I understand that I will be responsible for the charge.
Any pet requiring a bath, due to soiling prior to pick up will be bathed at the owner's expense.
I also authorize Montgomery Animal Hospital to do whatever is necessary should an emergency situation arise. Payment is required when animal(s) is/are released.
SIGNED: (Entering and submitting name in this form and will constitute signature. A signature will be required at check in.)
