Online Pet Boarding Form - Rice Village Animal Hospital

Your Name *

First

Last

Pet's Name *

Are you dropping off more than one pet for boarding? *

Yes
No

If the information is exactly the same for all pets, only one form is necessary. Be sure to include all belongings on this form. Otherwise please fill out check-in form for each pet.

My pet will be picked up on: (If there is a change to the date or time of discharge please advise us at boarding@ricevillageanimalhospital.com) *

Date

Time

How can we reach you while your pet is boarding? *

Primary Contact Name *

First

Last

Primary Contact Phone Number *

Alternate Contact Name

First

Last

Alternate Contact Number

Spaw Time!

Bath
Bath and Haircut

Bath and Haircut Instructions

Chow Time! *

How many cups per feeding?

Does your pet take medication?

Yes
No

Please list the medications and instructions. *

Medication Schedule

Once daily AM
Once daily PM
Twice daily
Other

Please explain. *

Please list any items that you are leaving with your pet with a brief description. While we do our best to ensure all items are returned in like condition, occasionally items are damaged or misplaced. Please do not bring any irreplaceable or sentimental items with your pet as we cannot accept responsibility for them.Please list any personal belongings that are left and a brief description of the item.

Leash Description

Collar Description

Carrier Description

Other Items

Does your pet have any pre-existing and/or current medical problems we should be aware of? Please explain.

Is there any other thing that we need to know about your pet that would help us? (Afraid of thunder storms, fractious, separation anxiety, etc.)

Has your pet been ill or showed any signs of illness in the past 2 to 4 weeks? If so, please explain.

Will someone else be picking up your pet?

Yes
No

Who will be picking up your pet?

First

Last

Phone Number

Proof of current vaccinations is required (Rabies, Distemper/Parvo, Leptospirosis, Canine Influenza H3N2/H3N8, Bordetella and negative fecal exam) for all boarders. If vaccinations cannot be confirmed by the time of check-in, we will administer the needed vaccines. An exam fee of $62.50 will be charged along with the costs of any vaccines given. *

I give permission to vaccinate my pet if he/she is overdue for distemper or rabies vaccinations.

If your pet becomes ill during his/her stay with us, a veterinarian will examine your dog or cat. We will make every attempt to contact you at the numbers you provide should your pet become ill while with us. Medical treatment will be provided at the discretion of the veterinarian on duty. All costs associated with any medical care given while boarding will be at the owners’ expense and due upon your pet’s release. *

I have read and understand the authorization for treatment.

In order to maintain a “flea free” environment, your pet will be checked for fleas upon admission. If fleas are present, your pet will be treated with flea medication (at the veterinarian’s discretion) at your expense. *

I have read and understand.

Boarding Registration Form