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" indicates required fields
Owner Name
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Phone
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Email
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Pet Name(s)
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Emergency Contact
Person to contact in case of an emergency (if anyone other than yourself)
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Emergency Contact Phone
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Initial: this stated person can make medical decisions for my pet in case I cannot be reached
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EMERGENCY: if we cannot reach you or your emergency contact, we may treat up to:
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DO NOT administer any medical treatment until specific authorization is given
Up to $250
Up to $500
Up to $1,000
Do whatever it takes
NON-EMERGENCY (ear infection, diarrhea, broken toenail, etc.): we may treat up to:
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DO NOT administer any medical treatment until specific authorization is given
Up to $250
Up to $500
Do whatever it takes
Stay Details
Drop-off Date
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Pick-up Date
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Pick-up Time
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AM
PM
Weekend boarding pick-up: Saturday 5:00–5:30pm; Sunday 8:00–8:30am and 5:00–5:30pm.
Name of Flea and Tick Prevention
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Date Flea and Tick Prevention Was Given
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Additional Services (check for yes)
Nail Trim: $25.00
Complimentary bath if boarding stay is 2 or more nights (baths do not include drying, brushing out or nail trims)
$15 bath if boarding stay is less than 2 nights (baths do not include drying, brushing out or nail trims)
Feeding
Feeding Instructions
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My pet(s) will eat food from home (enter the food below)
Purina EN provided by Tender Care Animal Hospital
Name of Food
Amount Fed
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AM or PM?
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AM
PM
AM and PM
Behavior & Health
Has your pet ever shown aggression to people or animals?
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Yes
No
If yes, please explain
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Has your pet ever shown possessiveness of food or toys?
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Yes
No
Is your pet a blanket chewer?
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Yes
No
Has your pet been ill in the last 30 days?
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Yes
No
If yes, please explain
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Medications
Pets requiring insulin OR 3+ medications will be charged Medical Boarding (Cats: $30/day) (Dogs: $36/day).
Medication 1
Medication 1: Dose & Frequency
Medication 1: Time Next Dose Due
Medication 2
Medication 2: Dose & Frequency
Medication 2: Time Next Dose Due
Medication 3
Medication 3: Dose & Frequency
Medication 3: Time Next Dose Due
Medication 4
Medication 4: Dose & Frequency
Medication 4: Time Next Dose Due
Signature
Client Signature (type your full name)
*
Today's Date
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