Boarding Form

Name*

First Last

Email*

Phone*

Emergency Contact #1*

First Last

Phone*

Emergency Contact #2

First Last

Phone

Pet Name*

Has your pet stayed with us before?*

Yes
No

Drop off Date*

Drop off Time*

: HH

MM

Please choose a time between 8:30am-11:00am or 2:00pm-5:00pm.

Pick-up Date*

Pick-up Time*

: HH

MM

What Brand of Food and Type of Container is food in?*

Feeding Amount*

Feeding Directions and Frequency*

Any additional services requested while boarding here?

Exam

If your pet needs an exam while here please answer the following questions.

Concerns

Do you have any other concerns you would like the doctor to address?

Heartworm & Flea Prevention

Please list name of product and date of when it was last given.

Medications

Please provide the name of medication, dosage, and frequency of medication to be given to your pet. All medications must be in their originally prescribed bottle with label.

Belongings left

Items left with your pet are left at your own risk. We strongly advise labeling your pet's belongings with your last name and pet's name. We would also like to remind all owners we discourage leaving pet bedding. We have beds, blankets and other bedding to help keep your pet comfortable during their stay. Please list below all items that will be left with your pet.

Canine Outdoor Time*

Old Towne Animal Hospital has an outdoor area and we strive to keep this area as secure as possible. Although we never leave pets unsupervised, some pets may try to escape from the area. If you are concerned your pet may try to escape, you may opt to only have your pet exercised on leash rather than free play. We encourage you to tour the area if you have concerns. I have read and understand the risks if my pet is off leash in the outdoor play area.

Would you like to add another pet?*

Yes
No

Pet #2

Pet's Name*

Has your pet stayed with us before?*

Yes
No

Drop off Date*

Drop off Time*

Please choose a time between 8:30am-11:00am or 2:00pm-5:00pm.

: HH

MM

Pick-up Date*

Pick-up Time*

: HH

MM

What Brand of Food and Type of Container is food in?*

Feeding Amount*

Feeding Directions and Frequency*

Any additional services requested while boarding here?

Exam

If your pet needs an exam while here please answer the following questions.

Concerns

Do you have any other concerns you would like the doctor to address?

Heartworm & Flea Prevention

Please list name of product and date of when it was last given.

Medications

Please provide the name of medication, dosage, and frequency of medication to be given to your pet. All medications must be in their originally prescribed bottle with label.

Belongings Left

Items left with your pet are left at your own risk. We strongly advise labeling your pet's belongings with your last name and pet's name. We would also like to remind all owners we discourage leaving pet bedding. We have beds, blankets and other bedding to help keep your pet comfortable during their stay. Please list below all items that will be left with your pet.

Canine Outdoor Time*

Old Towne Animal Hospital has an outdoor area and we strive to keep this area as secure as possible. Although we never leave pets unsupervised, some pets may try to escape from the area. If you are concerned your pet may try to escape, you may opt to only have your pet exercised on leash rather than free play. We encourage you to tour the area if you have concerns. I have read and understand the risks if my pet is off leash in the outdoor play area.

Would you like to add another pet?*

Yes
No

Pet #3

Pet's Name*

Has your pet stayed with us before?*

Yes
No

Drop off Date*

Drop off Time*

Please choose a time between 8:30am-11:00am or 2:00pm-5:00pm.

: HH

MM

Pick-up Date*

Pick-up Time*

: HH

MM

What Brand of Food and Type of Container is food in?*

Feeding Amount*

Feeding Directions and Frequency*

Any additional services requested while boarding here?

Exam

If your pet needs an exam while here please answer the following questions.

Concerns

Do you have any other concerns you would like the doctor to address?

Heartworm & Flea Prevention

Please list name of product and date of when it was last given.

Medications

Please provide the name of medication, dosage, and frequency of medication to be given to your pet. All medications must be in their originally prescribed bottle with label.

Belongings Left

Items left with your pet are left at your own risk. We strongly advise labeling your pet's belongings with your last name and pet's name. We would also like to remind all owners we discourage leaving pet bedding. We have beds, blankets and other bedding to help keep your pet comfortable during their stay. Please list below all items that will be left with your pet.

Canine Outdoor Time*

Old Towne Animal Hospital has an outdoor area and we strive to keep this area as secure as possible. Although we never leave pets unsupervised, some pets may try to escape from the area. If you are concerned your pet may try to escape, you may opt to only have your pet exercised on leash rather than free play. We encourage you to tour the area if you have concerns. I have read and understand the risks if my pet is off leash in the outdoor play area.

Please list anyone else authorized to pick up your pet

Emergencies*

Should your pet become ill, the doctors and staff at Old Towne Animal Hospital will provide all necessary medical care until we are able to stabilize your pet and reach you. Old Towne Animal Hospital is not staffed 24 hours a day. Should your pet need 24 hour assisted care, your pet will be transferred to a 24-hour emergency hospital. Please let us know if you agree or decline.

I agree to pay expenses related to emergency care
I decline any medical treatment

Signature*

Boarding pets are discharged only during regular business hours of Monday-Sunday 7:30-6:30 pm. I agree to complete payment at the time of discharge. I have read all of the above and I am in full agreement. Please enter your name below as your signature.

First Last

Monday	7:30am – 6:30pm
Tuesday	7:30am – 6:30pm
Wednesday	7:30am – 6:30pm
Thursday	7:30am – 6:30pm
Friday	7:30am – 6:30pm
Saturday	7:30am – 6:30pm
Sunday	7:30am – 6:30pm

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Boarding Form

Boarding Contract

Pet #2

Pet #3

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Boarding Form

Boarding Contract

Pet #2

Pet #3

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