Boarding Form - Stoney Creek Veterinary Hospital

THIS IS NOT A RESERVATION! FILLING OUT THIS FORM DOES NOT ENSURE THAT WE HAVE SPACE FOR YOUR PET! PLEASE CALL THE OFFICE TO RESERVE A SPACE FOR YOUR PET TODAY.
Client's Name*
First Last
Your Email*
Pet's Name*

Part 1 - FEEDING AND SERVICE NEEDS
I Will Pick Up My Pet This Date and Time
Date*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
I Brought My Pet's Own Food*
- Yes
- No
My Pet Is On A Special Diet*
- Yes
- No
Please List Pet's Special Diet
My Pet Eats (please check one)*
- A.M. Only
- P.M. Only
- A.M. and P.M.
- At Will
My Pet Eats (list amount)*
My Pet's Next Feeding Is At
Date*
Date Format: MM slash DD slash YYYY
Time*

: HH

MM
My Pet Needs A Bath, Brush Out And Nail Trim **If having a bath, pick up is after 4:30p and before 6:00p*
- Yes
- No
My Pet Needs A Nail Trim Only*
- Yes
- No
My Pet Needs His/Her Anal Grands Expressed*
- Yes
- No
I Have Pre-Arranged Grooming With Susan*
- Yes
- No
My Pet Needs An Examination (Please specify)
I Am Leaving The Following Items With My Pet (Press the + button to add multiple items). Although we try to make sure your pet goes home with what he/she came with, we are not responsible for lost items or items left here while boarding.
Please See Specific Notes About My Pet Listed Below

Part 2 - MEDICATIONS
My Pet Is On Medications*
- Yes
- No
List Medication, Dosage, and Next Dosage Time (click the + button to add multiple medications)

Part 3 - EMERGENCY INFORMATION
Please Do Not Treat My Pet If He/She Becomes Ill Without Calling Me First*
- Yes, call me before treating
- Yes, please treat my pet prior to calling
Please Treat My Pet Up To This Dollar Amount If He/She Becomes Ill Before Calling Me*
Two Emergency Numbers That I Can Be Contacted At Are
Emergency Phone Number*
Emergency Phone Number
I understand my pet will be treated for any internal/external parasites noticed while boarding. By checking this box, you accept these terms.*
- I accept these terms
I Want My Pet To Have Play Time When Available ($7.00 per half hour)*
- Yes
- No
Enter Number Of 30 Minute Increments*