Boarding Form Council Veterinary Hospital in Bethany, OK

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Boarding Form

Please fill out this form as completely and accurately as possible for boarding admission.

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Date *

Animal *

Last Name *

Breed *

Phone *

Species *

Sex *

color *

Phone # While Away: *

Date of Departure *

Emergency Contacts *

Date of Return *

Medical Conditions *

Medication’s Administered *

We thank you for boarding your pet at Council Veterinary Hospital, where we have our boarders׳ health and comfort in mind. Before you depart, we ask that you take a moment to review the following vaccinations and, with the assistance of our staff, circle any that have NOT been administered within the specified times OR for which you do not have documentation. For the health of your pet and our other boarders, we are required to administer the out-of-date vaccinations prior to your pet׳s stay and you will be billed our standard fees for them.

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Dogs: Rabies(1yr)

Cats: Rabies(1yr)

Feline Leukemia/Feline Immunodeficiency virus status: positive

Negative

Distemper/Parvo

Bordetella

In order to maintain a flea-free environment for the comfort of all the pets staying with us and the homes of their owners, your pet will be checked for fleas and treated, if necessary, with a safe, effective, widely used, EPA approved product. In addition to providing the basic boarding of your pet, we also provide a number of other services. Please check and/or specify any additional services you wish us to provide for your pet. *

Boarding Bath Discount (10% off Grooming Bath Price)
Administration of Medication(s): [drug(s), dosage(s), time(s) adm’d]
Annual comprehensive physical examination, blood chemistry analysis or urinalysis
Microchip

I authorize the staff at this facility to perform the procedures listed above and, in the event of an emergency, any medical or surgical procedures necessary for the health and immediate well-being of my pet. I agree to pay in full for my pet׳s boarding and for emergency and/or requested medical care at the time of discharge.

I am leaving the following articles:

Item: *

Color: *

Labeled: *

Medications *

Food: Yes/No *

cups 1x/2x/3x per day *

I certify that I am the owner or the owner’s authorized agent of this pet.

Signature

Date *

Comment

Boarding Form Council Veterinary Hospital in Bethany, OK

Boarding Form

I am leaving the following articles:

I certify that I am the owner or the owner’s authorized agent of this pet.

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