Tri-State Veterinary Center Boarding Admission Form

All pets must be up-to-date on all all vaccines in order to be boarded.

Owner and Contact Information:

Checked in by:

Check-in Date:

Check-in Time:

Pet(s):

Check-out Date:

Check-out Time:

Owner:

Account #:

Phone:

Call AM/PM?

Email:

Daily phone update?

Emergency Contact:

(other than owner)

Name:

Phone:

Discharge Pet to:

Name:

Phone:

Vaccinations Needed:

Date received or due date

Animal:

Medication:

Daily medication charge: $1.50/day

Name of Medication:

Dose:

Time Last Given:

Quantity brought in:

Frequency:

Feeding:

In-house feeding charge $1.50/day

In-house food:

Amount:

Client's Food:

Frequency:

Description of Pet's Belongings:

Important medical concerns? (Diabetes, seizures, etc.):

Does your pet interact well with other animals and humans? (Aggressive, shy, nervous, etc.):

Optional services:

Please check all that apply

Anal Glands:

$ 15.00

Extra Play:

$ 5.00 per day

Extra Walk:

$ 4.00 per day

Other:

Nail Trim:

$ 7.00

Clean Ears:

$ 12.00

Bath:

Signature:

Monthly Shot Clinic

Tri-State Veterinary Center Boarding Admission Form

All pets must be up-to-date on all all vaccines in order to be boarded.

Owner and Contact Information:

Checked in by:

Check-in Date:

Check-in Time:

Pet(s):

Check-out Date:

Check-out Time:

Owner:

Account #:

Phone:

Call AM/PM?

Email:

Daily phone update?

Emergency Contact:

Name:

Phone:

Discharge Pet to:

Name:

Phone:

Vaccinations Needed:

Animal:

DHP Date

BP Date

RV Date

FELV Date

FVRCP Date

RV Date

Medication:

Name of Medication:

Dose:

Time Last Given:

Quantity brought in:

Frequency:

Feeding:

In-house food:

Amount:

Client's Food:

Frequency:

Description of Pet's Belongings:

Important medical concerns? (Diabetes, seizures, etc.):

Does your pet interact well with other animals and humans? (Aggressive, shy, nervous, etc.):

Optional services:

Anal Glands:

Extra Play:

Extra Walk:

Other:

Nail Trim:

Clean Ears:

Bath:

Signature: