Boarding Admission Form Owner's Name: _______________________________________________________________ Phone #:_______________________ Alt. Phone #: _____________________________ Pet's Name: ______________________________ Patient # (office use): _________________ Admission Date/Time:_____________ Estimated Discharge Date/Time:_______________   ALL ANIMALS ADMITTED MUST BE CURRENT ON THEIR VACCINATIONS! WRITTEN PROOF OF VACCINATIONS OR VERIFICATION WITH THE PET'S VETERINARIAN MUST BE PROVIDED BEFORE BOARDING YOUR PET(S)! ANIMALS MUST ALSO BE FREE OF EXTERNAL PARASITES! ANY ANIMAL FOUND TO HAVE FLEAS OR TICKS WILL BE TREATED AT THE OWNER'S EXPENSE! The undersigned acknowledges that other animals will be located on the premises and hereby authorizes the necessary care and treatment for any condition that may endanger said other animals and hereby agrees to pay the customary charges for such treatments. This includes, but is not limited to, parasites, and infectious viruses. The undersigned further acknowledges that no guarantees have been made except reasonable precautions against injury, escape or illness with the understanding that the undersigned will remain fully responsible for the cost of all services provided by Southwest Plaza Animal Clinic and its staff.   Emergency Contact Name:____________________________ Phone #: ______________ Pet's Medication(s): ____________________________ Dose:__________________ ____________________________ Dose:__________________ ____________________________ Dose:__________________ Feeding Instructions:__________________________________________________________________________   Additional Authorized Work: (check all that apply) - 1/2 Price Boarder Bath (includes toenail trim) Yes:___ No:___ - *Annual Exam and Vaccinations (includes rabies, DHPPV, heartworm test, fecal examination and bordetella)* Yes:___ No:___ (*Vaccines required to be current for boarding are; Rabies, DHPPV annual bordetella and fecal.) -Please update only the following vaccinations: __________________________________________ -My pet is current on all vaccinations: __________ (If you are a new client or patient to Southwest Plaza Animal Clinic, please fill out our new patient and/or client information sheet to bring in with you. Please provide us with any current vaccination information you may have on your pet.)   Full payment is expected at time of discharge. If the pet is to be picked up by someone other than the owner, arrangements must be made with the veterinary clinic regarding the bill.   Owner's Signature:______________________________________________ Date:_______________________
Please print out this form, fill in the information, and either bring it along with your pet, or FAX it to 866-866-7558
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