Feline Boarding Admittance Form

Owner: <first-name> <last-name> / Patient: <animal>
Date: <date> / Breed: <breed>
Case No: <number> / Sex: <sex-name>
Street: <address> / Age: <age>
City: <city> / Color: <color>
Phone: <phone>

<animal-pic>

Feline Boarding Admittance Form

In order to make every pet’s stay safe, enjoyable, and worry-free,

we have the following requirements:

lAll vaccines up-to-date

lIntestinal Parasite Test performed within the past 12 months

lFree of External Parasites

Boarding Options
☐One Cage (2505) $ 27.50/night x ____ night(s)
☐ Kitty Condo (2514) $ 29.70/night X ____night(s)
☐ Additional cat – Kitty Condo (2515) $19.00/night x ____ night(s)

We do everything possible to make your cat’s stay with us comfortable and enjoyable!

Our Veterinarians do not personally examine your pet every day, but are available should an Animal Care Aide notice anything out of the ordinary. It is important for you to make a selection below and include an emergency contact in order for us to make the best decisions possible for your pet’s care. If medical care is required, and has been authorized, additional fees will be incurred.

* We cannot be held responsible for loss or damage of personal items due to destruction by your pet through no fault of the Emeryville Animal Hospital.

In case of an Emergency I can be reached at ______(phone #)

E-mail address ______

☐ Perform procedures the Doctor feels are necessary ☐ Do not perform necessary procedures, call first

I authorize ___ at # to act on my behalf in case of an emergency

Admitting Animal Care Aide ______Weight upon Admittance: ______

Admit Date:______Discharge Date: ______Approximate Pick-Up Time:______

Client Signature: ______Date: ______

MANDATORY REQUIREMENTS FOR ALL BOARDERS
Physical exam within past 12 months ☐Completed ☐Required
Intestinal Parasite Test performed within past 12 months ☐Completed ☐Required
Rabies vaccine within past 3 year ☐Completed ☐Required
RVT Admittance (if any procedures to be completed during pet’s stay) ☐ yes ☐ no
RVT Pre-boarding exam (if no exam performed within the past 30 days) ☐ yes ☐ no
☐ Free waterless Bath (after 4 nights)
☐ Discounted Boarding Bath, if less than 4 nights (2600) $29.00 -pending grooming availability
☐ Nail Trim (212) $8.00 ☐Brush Teeth Daily (704) $5.00 ☐ Clean Ears (141) $33.80
☐Intestinal Parasite Test (600) $ 39.00 ☐ Express Anal Glands (195) $42.50
☐ CapStar Administration. This is a fast acting oral flea treatment, to ensure your pet is free from fleas upon departure. Offered FREE OF CHARGE. (2518)
☐Please give ☐Do not give
☐ Grooming. Please discuss availability with reception and cost with groomer
Cost Quoted:______Date Booked: ______
☐ Medication(s) to Be Administered. Free of Charge
Medication Name______Dose: ______Frequency:______
Medication Name:______Dose: ______Frequency:______
Medication Name:______Dose: ______Frequency:______
Medication Name:______Dose: ______Frequency:______
Medication Name:______Dose: ______Frequency:______
☐Diet
Brand:______Amount: ______When: ______Can treats be give? ☐ Yes ☐ No
☐ Allergies/Conditions/Alerts: ______
☐Belongings being left with us:
______
______

Extra Services Available