Golden Lantern Animal Hospital Boarding Check-In
TalegaAnimalHospital Boarding Check-in
We understand this form takes about 3 minutes to fill out. It is so important for us to understand your pet’s boarding needs before you leave. Please pay special attention to the feeding allergy sections we need you to fill out. If your pet requires medications you will fill out a separateMedications Information Sheet. This will take an additional
2-5 minutes depending on how many medications your pet is currently taking. Thank you for understanding.
Client Name: ______Pet staying with us: ______►►Special Needs:__Geriatric __Blind/Deaf __Diabetes __Fear Biter
Phone numbers where we can reach you: ______and______
In case we can not reach you – may we have an alternative contact name and phone number?
Name:______Relationship: ______Phone: ______
Do you authorize this person to make emergency decisions for your pet if we can not reach you? YES NO
May we take pictures of your pet during their stay? YES NO May use your pet's photo on our website or social media? Y N
My pet is boarding until: ______
We close Monday - Friday at 6:00pm. Saturdays and Sundays at 5:00pm. Try to arrive ½ hour prior to closing time for pick up
Would you like your pet to receive a BATHor professional GROOMING before you pick up?
Circle One: 1. Bath & Blow Dry 2. Professional Grooming 3. Furminator 4. No
Additional fees apply – Please ask your Receptionist for a quote.
If you choose to have your pet’s bathed or groomed please plan to pick up after 4pm
If you would like your pet picked up earlier – request a bath for the day before you pick up.
►► Did you bring your own food? Yes No If not, we will feed the appropriate Science Diet dry food.
Talk to your Receptionist if your pet requires a specialty diet that you did nt bring.
How many times a day do you feed your pet? 1X 2X 3X When: MORNING NOON EVENING
How muchdo you feed your pet? ______
Special Feeding Instructions: ______
Is your pet Food Aggressive? YES NO
Is your pet boarding in the same cage with your other pet(s) that requires separation while eating? YES NO
Next feeding for my pet should be: Choose one: TODAY TOMORROW Choose one: MORNING NOON EVENING
►►Is your pet on anymedications?
NO / YES -PLEASE REQUEST A “MEDICATIONS SHEET” TO FILL OUT.
If you answered yes, you must fill out a new“medications sheet” each and every time you leave your pet with us.
►► Does your pet have any allergies to medications, vaccines or foods? Yes No
If yes, what are the known allergies: ______
While my pet is boarding at TalegaAnimalHospital, I would like my pet to receive: (circle all that applies)
Doctor’s Exam $68.00 Microchipping $68.50 Fecal Test for Parasites $48.00 Toe Nails Trimmed - Quote
______Annual Exam * Problems or symptoms my pet is having: ______
►► Please label all of your pet’s belongings.
Description of Belongings:
Iunderstand that leaving any belongings, including leashes and collars, is at my own risk. I give permission to TalegaAnimalHospital to give my pet any vaccines that are due or are needed to board. I understand that the vaccines that are needed are: (Dogs) DHPP, Bordetella and Rabies (Cats) FVRCP-C, Felv and Bordetella. I give TalegaAnimalHospital permission to treat my pet as needed for any medical condition that might arise while boarding, including emergency treatments. I understand the hospital staff will attempt to contact me prior to treatment for non-emergency care. I understand that continuous presence of personnel will not be provided during nighttime hours and some daytime hours. I understand that my pet will be treated with Capstar®, an oral flea treatment upon arrival. The cost is included in our boarding fees. I understand cat litter is scooped twice daily and dogs are walked minimally 4 times daily. I understand TalegaAnimalHospital provides food, fresh water and freshly laundered blankets and towels everyday to their boarding guests.
______4-15-13
Signature of Owner or Authorized Agent Date