BOARDING CHECK-IN

Check In:_______  Pick-up:_______

Address:______________________________________________________________________

Home #:__________________ Work #: ____________________Cell #: ___________________

Species: _____________ Breed:_________________________ Gender: _________________

Thank you for boarding your pet with us while you are away. Please take a moment to fill out this form so your pet’s stay with us is a healthy and happy one.  We provide a safe environment for your pet, but understand that occasionally medical concerns do arise while a pet is boarding. If this should occur, we would like to be able to reach you or a trusted person to guide us in your pets care.

Emergency contact:____________________________________________

Additional phone: ___________________

In the event you cannot be reached, the staff at Nelson Animal Hospital will provide medical care for your pet.  In the case of a more serious condition that we feel 24 hour medical care is needed, would you allow the transfer of your pet to a 24 hour facility? Y__ N__

I understand that Nelson Animal Hospital is not responsible for damaged toys or belongings, but will make every effort to return all listed items.

Personal belongings please list:__________________________________

_____________________________________________________________

Medications: Y__ N__ (PLEASE ADVISE US IF THE DOSAGE SCHEDULE IS DIFFERENT THAN ON THE VIAL)

Any additional notes:___________________________________________

_____________________________________________________________

Signature:________________________________Date:____________