Boarding Form For Canines

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BOARDING FORM FOR CANINES
Boarding dates _________
4907 Prytania St. New Orleans, LA 70115
Pet Name:_________________________ Owner’s first & last name__________________________________________
O
O
Are dog’s vaccinations current?
YES
NO
Date of last vaccinations_________
OFFICE USE:
O
O
Reminders due_______________________
FECAL date_____ results______
Owner notified
YES
NO
MEDICATIONS
O
O
Is your pet ON a monthly heartworm preventative?
NO
YES
What brand?____________________
O
O
Does your pet NEED a dose while boarding?
NO
YES Purchase?_____ Quantity?_____Date?______
O
O
Is your pet ON a monthly flea preventative?
NO
YES
What brand?__________________________
O
O
Does your pet NEED a dose while boarding?
NO
YES Purchase?_____ Quantity?_____Date?_____
O
O
Is your pet on any other medications/ treatments?
YES (fill out chart below)
NO
Med**/ Tx*_________________________________ Times/day____ #Txs needed today____ Own meds
Y/N*
Med**/ Tx*_________________________________ Times/day____ #Txs needed today____ Own meds
Y/N*
Med**/ Tx*_________________________________ Times/day____ #Txs needed today____ Own meds
Y/N*
Med**/ Tx*_________________________________ Times/day____ #Txs needed today____ Own meds
Y/N*
DIET
We feed maintenance formulas of Science Diet® to our boarders based on their age. Prescription Diets® are
an additional fee. Diet: ______________________
O
I
brought my own food. Brand: __________________ (if your dog runs out, we will feed them Science Diet®)
O
O
O
O
Feed my dog:
once a day
twice a day
free feed
other_________ How much?_____________
O
O
O
O
Does your pet need to be fed today?
YES
NO If yes, feed AM
PM
O
O
O
Do we have your permission to make necessary diet changes?
YES*
NO
Call first
O
O
O
Do you authorize us to do any necessary medical treatments?
YES*
NO
Call first
BATHS
O
O
Complimentary out bath for dogs who are boarding 3 or more nights?
YES (pick-up after 3 PM)
NO
O
O
Do you want us to bathe your pet if he/she is boarding for less than 3 nights?
YES*
NO
PLEASE CHECK ANY OF THE FOLLOWING PROCEDURES AND/OR SERVICES THAT YOU WOULD LIKE US TO
*
PERFORM WHILE YOUR PET IS STAYING WITH US
OExpress anal
Doctor
examination*
(Dr.Ghere/ Dr. Nathan/
glands*
Dr.Biondolillo/ Dr. Foster)
OGet a HomeAgain
Microchip™*
Reason:______________________________
OTrim
nails*
____________________________________
O
O
Do you want your dogs to board together?
YES
NO
*__________________________________________________________________
Special Instructions
In order to preserve a flea-free environment, your dog will be given a Capstar® upon entry ($5.70).
*Service may require an additional charge. Please ask for prices.
**There is an oral medication fee of $1.80 per administration.
Signature of owner or responsible party _____________________________ Emergency contact #___________________
Please print name __________________________________________________________________________________
O
O
O
O
O
OFFICE USE:
BOCACI
NTCI
BCI
EXAMCI
EXAGCI

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