Canine Boarding Form in Milwaukie, OR - Gladstone Veterinary Clinic

Pet Name *

Client Name *

First

Last

Phone *

Email *

I would like to be contacted with updated on my pet while boarding *

Yes, through text message
Yes, through email
No

Boarding Start Date *

Date

Time

Boarding End Date *

Date

Time

Feeding Instructions:

Please state the brand/type of food. Quantity in cups or scoops and the frequency.

Dietary restrictions

Medications and Supplements

Please state the name and concentration of medication. The does/frequency and the amount brought.

Belongings

Please describe all belonging during stay (toys, bedding, collar/leash, food, food container, treats, etc.)

For both your pet’s protection, and the protection of all other boarding guests and hospitalized patients, all rabies, distemper/parvo, leptospirosis, Bordetella, and influenza (C3N8 & C3N2) vaccines must be current during the duration of the boarding period. *

I have read and understand

A negative fecal exam, including giardia, must be performed within the past 12 months. *

I have read and understand

All boarding patients must be free of fleas and other external parasites. One of our team members will check your pet for evidence of fleas at check in. If evidence of fleas is found at that time, or at any time during your pet’s stay, your pet will be treated topically using Frontline Gold, at your expense. *

I have read and understand

Last flea product used:

Date given:

I authorize GVC to board my animal during the above dates. *

I have read and understand

I authorize GVC and its doctors to evaluate my pet’s condition in the event of undue stress while boarding, and prescribe and administer sedating medication to maintain my pet’s comfort. I assume all costs associated with examination, medication, and medication administration. *

I have read and understand

In the case of illness, emergency, or accident, GVC has my permission to administer emergency treatment until I or my authorized agent can be contacted to authorize further treatment. I understand that in the event that my authorized agent or I cannot be contacted, the doctors at GVC will administer treatment deemed necessary for the health, safety, and well being of my pet while under the care and supervision of GVC. I understand that I am responsible for any costs associated with any diagnostic tests or treatment performed. *

I have read and understand

Full payment is required in order for my pet to be discharged *

I have read and understand

Digital Signature *

Date *