Daycare/Boarding History Form
Date: Client Name: Address: Telephone: Emergency #: Emergency #: Patient Name: Breed: Sex: Color/Markings: Birth date: Please tell us a little about your pet. 1. Does your pet have any behavioral issues? This may include aggression toward certain subjects, possessiveness, anxiety, bad habits, etc. The more we know about your pet, the better we can attend to his/her needs. (YES or NO) YESNO If yes, please elaborate. 2. Does your pet have any health issues? If yes, please elaborate. (YES or NO) YESNO 3. Is your pet on any medication? If yes, please indicate medication and dosage. (YES or NO) YESNO 4. Does your pet have any allergies? If yes, please elaborate. (YES or NO) YESNO 5. Please specify your pet’s feeding instructions.If you did not bring your pet’s food, or if your pet runs out of food, we will supply Hills“Digestive Care” dry food for an additional cost of $4.00 per day. 6. In the event your pet is not eating, may we provide a small amount of Hills “Digestive Care”canned wet food? YES or NO YESNO 7. Is your pet okay to be given bedding and blankets for their stay? (YES or NO) YESNO 8. Please include any useful commands/words your pet may follow. We will try our best to enforce these good behaviors! 9. May we assess and include your pet in our daycare? YES or NO YESNO 10. May we use photos of your pet for our website/social media pages? (YES or NO) YESNO ● All boarding animals must be current on all necessary vaccinations, have had a negativefecal sample within the past 12 months, be spayed/neutered if older than 6 months, andhave had a pre-boarding exam by one of our veterinarians.● All animals must be free of external parasites or will be treated at the owner’s expense.● Harbor Animal Hospital is not responsible for any items lost or damaged during yourpet’s stay.● Pets must be picked up before 12 PM or will be charged an additional late fee. I acknowledge that in the event of my pet’s illness, the staff at Harbor Animal Hospitalmay not be able to contact me immediately, however, I authorize Harbor Animal Hospital toinitiate appropriate treatment until I can be reached. I request that Harbor Animal Hospitalprovide all medical/surgical treatments it deems necessary, with fees not to exceed $ ,until I am available to discuss further care with the attending veterinarian. I acknowledge that Harbor Animal Hospital does not have a veterinarian on staff at allhours. In the event that my pet becomes severely ill and no doctor is on staff, I authorize thetransport of my pet to the nearest emergency hospital. I will assume all financial responsibilityfor the transport and immediate emergency care of my pet.Owner Name: Date: Owner Signature
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Document Name: Daycare/Boarding History Form
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