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) If yes, please elaborate.
2. Does your pet have any health issues? If yes, please elaborate. (YES or NO)  
3. Is your pet on any medication? If yes, please indicate medication and dosage. (YES or NO)  
4. Does your pet have any allergies? If yes, please elaborate. (YES or NO)  
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 7. Is your pet okay to be given bedding and blankets for their stay? (YES or NO) 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  
10. May we use photos of your pet for our website/social media pages? (YES or NO)  

● All boarding animals must be current on all necessary vaccinations, have had a negative
fecal sample within the past 12 months, be spayed/neutered if older than 6 months, and
have 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 your
pet’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 Hospital
may not be able to contact me immediately, however, I authorize Harbor Animal Hospital to
initiate appropriate treatment until I can be reached. I request that Harbor Animal Hospital
provide 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 all
hours. In the event that my pet becomes severely ill and no doctor is on staff, I authorize the
transport of my pet to the nearest emergency hospital. I will assume all financial responsibility
for the transport and immediate emergency care of my pet.
Owner Name: Date:

Owner Signature

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Signature Certificate
Document name: Daycare/Boarding History Form
lock iconUnique Document ID: 31835b602fea8e495d52796fca0b436d1a5aec2c
Timestamp Audit
October 20, 2020 8:56 am EDTDaycare/Boarding History Form Uploaded by Harbor Animal Hospital - support@designswizard.com IP
December 31, 2020 6:40 pm EDT Document owner support@designswizard.com has handed over this document to clientservices@harboranimalhospital.org 2020-12-31 18:40:11 -