DAY Boarding Form in Lumberton, TX | Main Street Veterinary Clinic

Name

This field is for validation purposes and should be left unchanged.

Client Name*

First Last

Check In Date*

Check In Time*

Patient*

Species*

Canine

Feline

Breed*

Age*

Years

Months

Canine / Feline Day Boarding $20 + tax – Special Handling Fees May Apply ($15/day)

Do you want a bath while here?: mark “declined” in computer if says No*

($60 + tax Additional Fee) If Yes, Pick-up AFTER 3pm unless Called

Yes

Brush Out Additional $30 or more for long hair dogs/cats.*

Initial here

DAY EMERGENCY CONTACT INFORMATION:

Owner's Name*

First Last

Phone*

Phone

Local Agent's Name

First Last

Phone

PLEASE ANSWER BELOW QUESTIONS:

Are we feeding today while here?*

Yes

Feeding Instructions*

Main Street Vet provides Purina EN dry food for Dogs/ SD maintenance dry food for Cats.

Owner Provided

Name*

(Label owner’s food)

# of Meals/day*

one

two

three

Amount fed per meal*

(cans/cups)

Additional instructions*

Are we giving medications while here?*

Yes

Medication Admin. ($10/day additional fee): {oral, topical, insulin, etc}

(Drug name) ex: Cephalexin

(How Much) ex: 1 capsule

(How Often): ex: BID

Current Known Medical Problems

Can your pet have blankets and/or bed in the kennel?*

Will they destroy? If Yes, then we will not put into kennel.

Yes

Pick-up Times : Boarders are released ONLY during our normal office hours. We will NOT release a pet before or after our normal office hours. If you have requested to have your pet bathed at the end of their stay, please pick your pet up after 3pm to allow for adequate drying time.

PLEASE INITIAL HERE INDICATING THAT YOU UNDERSTAND OUR PICKUP TIMES

Parasite Control Requirement:

In order to maintain a flea-free environment for all of our guests, all pets that arrive for boarding are inspected for evidence of flea infestation. If your pet is found to have fleas, it will be treated at your expense. If you recently applied prescription flea control to your pet, please indicate below:

Name of product applied

Date of application

Please note: if we notice pet has live fleas, additional flea control will be administered at your expense ($40), regardless of when recent product was applied)

PLEASE INITIAL HERE INDICATING THAT YOU UNDERSTAND OUR VACCINATION REQUIREMENT

DAY BOARDING AUTHORIZATION

I am the owner or agent for (pet name) and I have the authority to execute this consent. I authorize the veterinary staff at Main Street Veterinary Clinic to treat my pet if it should become ill while day boarding until I can be reached and to do whatever is necessary should an emergency situation arise. I understand that medical supervision is available during normal office hours. I authorize outdoor leashed walks for my pet and exercise in a fenced yard. I understand that any examination, bath, vaccines, special handling charges, etc are at additional cost to me and are subject to change without prior notice. I have read and I understand the policies stated above and understand that payment is due at the time of pick-up.

Signature (Owner/Agent)*

Date*