Tails-A-Waggin Animal Hospital - New Boarding Client Form

Client Information

Please provide the information below as completely as possible. All information is strictly confidential. If your reservation is for a holiday or around a holiday please call for reservations

Name(Required)

First Last

Email(Required)

Home Phone(Required)

Work Phone

Cell Phone

Address(Required)

Street Address Address Line 2 City State ZIP Code

Pet Information

Pet's Name(Required)

Pet's Breed(Required)

Pet's Weight(Required)

New Boarder?

Yes

Name of Flea/Tick Prevention(Required)

(must have TICK prevention)

Flea/Tick Prevention Date Applied

MM slash DD slash YYYY

Additional Info

Type of Kennel:(Required)

Groom(Required)

Yes

Bath(Required)

Yes

Group Play(Required)

Yes

Paw Pops (Frozen Yogurt Treats)(Required)

Yes

Individual Play(Required)

Yes

Group Pool(Required)

Yes

Individual Pool(Required)

Yes

Special Notes

Brand of food & feeding instructions:

(please bag food for each individual serving in a zip lock baggie)

Number Of Bags

Medical Problems

Name of your Veterinarian

Veterinarian phone number

Dates of Boarding

Drop Off Date(Required)

MM slash DD slash YYYY

Approx. Drop Off Time

Hours

Minutes

AM/PM

Pick Up Date(Required)

after 2:00 pm if having groom/bath

MM slash DD slash YYYY

Pick up is Sat or Sun either 8 AM or 5 PM at the right side of the building. - must be PREPAID

*Note: We will contact you with availability for the dates you have requested.

Emergency Contact Information

Contact Name and Number

Medications and Special Instructions

Please list special conditions, medications, dosage, frequency, etc.

Being away from home can be a stressful experience for some pets. I give permission for treatment and assume payment if my pet becomes ill while boarding.

I Agree to the terms above:(Required)

Yes

Additional Questions

Please Read And Sign

I understand that if my pet enters the Pet Resort with fleas or ticks that it will be treated at my expense. All vaccinations must be current within 1 year and Bordetella within 6 months. In case of emergency or illness I authorize the veterinarian to treat my pet using our veterinarian and I am responsible for all charges. If medications are necessary for treatment I give my permission to administer such medications.

Fax over your records to 239-482-7922 or email: tailsawagginanimalhospital@comcast.net

Client Signature(Required)

Emergency Phone(Required)

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