Clayview Animal Clinic:  Boarding Information

OWNERS NAME_______________________PETS NAME_______________________

CHECK IN DATE____________________CHECK OUT DATE___________________

PHONE NUMBER WHERE YOU CAN BE REACHED__________________________

ALTERNATIVE EMERGENCY CONTACT NAME AND PHONE NUMBER

________________________________________________________________________

Ø  IS YOUR PET ON A SPECIAL DIET?__________________________________

Ø  SPECIAL FEEDING INSTRUCTION___________________________________

Ø  IS YOUR PET ON ANY MEDICATION?_______________________________

Ø  There will be $1.00 charge per medication given in the hospital.

DIRECTIONS?_____________________________________________________

Ø  HAS YOUR PET EXPERIENCED ANY RECENT ILLNESSES?____________

Ø  If  YES, PLEASE DESCRIBE THE ILLNESS:

__________________________________________________________________

Ø  TEMPERMENT, ANY FEARS, ABNORMALITIES, OR HABITS WE SHOULD BE AWARE OF?___________________________________________

Ø  WHAT PERSONAL ITEMS DID YOU BRING FOR YOUR PET?_____________________________________________________________

(CLAYVIEW ANIMAL CLINIC IS NOT RESPONSIBLE FOR SMALL TOYS OR CHEW BONES LEFT WITH THE ANIMALS DURING THEIR STAY)

ALL ANIMALS MUST BE VACCINATED TO BOARD WITH US.  IF YOU CANNOT PROVIDE WRITTEN PROOF THAT THESE VACCINATIONS ARE CURRENT, THEY WILL BE ADMINISTERED AT YOUR COST.

Ø  DOGS MUST HAVE DISTEMPER, CORONA, RABIES, AND BORDETELLA

Ø  CATS MUST HAVE DISTEMPER, AND RABIES

Ø  VACCINES NEEDED_______________________________________________

INITIAL:__________

BOARD BEGINS ON THE DAY THE PET ENTERS THE HOSPITAL REGARDLESS OF THE TIME OF DAY.  THE PET MUST BE PICKED UP BEFORE 9:00 AM ON THE DAY IT IS TO BE RELEASED IN ORDER NOT TO BE CHARGED FOR THE DAY.

WE OPEN AT 7:30 AM, PLEASE ALLOW SOME TIME WHEN PICKING UP YOUR PET.  THERE MAY BE OTHER PEOPLE AHEAD OF YOU WHICH CAN  RESULT IN A SHORT WAIT.  IF THERE IS AN EMERGENCY WITH YOUR PET AND YOU CANNOT BE REACHED, THE VETERINARIAN ON DUTY HAS PERMISSION TO TREAT YOUR ANIMAL AS HE OR SHE DEEMS NECESSARY, AT YOUR EXPENSE UNTIL YOU CAN BE REACHED.  INITIAL:__________

WE STRIVE TO MAINTAIN A FLEA FREE ENVIROMENT AT CLAYVIEW ANIMAL CLINIC.  IF ANY FLEAS ARE FOUND ON YOUR PET, WE WILL APPLY A TOPICAL FLEA CONTROL PRODUCT AT YOU EXPENSE.  IF YOU WOULD LIKE ONE APPLIED AS A PRECAUTION PLEASE ASK THE RECEPTIONIST.  INITIAL:_______.  WE DO OFFER CAPSTAR UPON DISCHARGE AT A CHARGE OF $4.00.  THIS IS AN ORAL PILL THAT KILLS FLEAS FOR 24 HOURS.

CAPSTAR UPON DISCHARGE FOR $4.00:       YES              NO

INITIAL:__________

ADDITIONAL OPTIONS

Ø  WOULD YOU LIKE YOUR PET BATHED BEFORE IT GOES HOME?____________________

IF YOUR PET REQUIRES EXTRA BRUSHING THERE WILL BE AN ADDITIONAL CHARGE STARTING AT $15.00 AND UP.

Ø  WOULD YOU LIKE FOR YOUR PET TO HAVE EXTRA WALKS?_______________________

Ø  WOULD YOU LIKE EXTRA PLAYTIME FOR YOUR PET?_____________________________

     (EXTRA WALKS AND PLAYTIMES ARE AN ADDITIONAL $2.50 EACH)

SIGNATURE:__________________________________________________  DATE:___________________

RECEPTIONIST INITIALS:______________