Diabetic Condo Admission Form
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1DIABETIC CONDO ADMISSION FORM
Client Name_______________________________________
Pet name____________________________________
For pet’s protection, all vaccines must be current. If not, treatment will be done and fees will apply.
Last Vaccine’s given: Rabies___________________________________
FRCP___________________________________
Other____________________________________
Food:
My pet:
AM:
Dry Food. Amount: _______________________
□ Always finishes his/her food.
Wet Food. Amount: _______________________
□ Eats ½ to ¾ of food.
PM:
Dry Food. Amount: _______________________
□ Eats lightly.
Wet Food. Amount: _______________________
□ Other: ________________________________
**If food runs out, we will select the appropriate replacement and add it to your invoice.
Normal Water Consumption:
High □ Normal □ Low □
Normal Urine Volume: High □ Normal □ Low □
Special Instructions: ________________________________________________________________________
_________________________________________________________________________________________
Articles that you brought: ____________________________________________________________________
Insulin:
Type of insulin: ________________________________________________
AM unit amount: ____________
Time: _____________
PM unit amount: ____________ Time: _____________
Last given: _______________________________________
Other Medications:
Medication
Dose
Frequency
Last Given
1)
2)
When was your pet last tested to determine blood-glucose levels? ____________________________________
Any recent vomiting or diarrhea? ______________________________________________________________
How is your pets appetite in response to stress? ___________________________________________________
Any other health issues? _____________________________________________________________________
**Once in boarding, animals that are not eating or are otherwise doing poorly, may be hospitalized at the owner’s
expense. Hospitalized boarding can range from $80-100/night plus any additional medical costs associated with their
stay.** We will call the emergency contact before any treatment is performed.
**If your pet requires a Doctor’s attention, I give you permission to treat:
Yes_____
No_____
Up to $_________
Emergency contact or Person who has authority to make decisions about pets care and/or treatment
1.__________________________________ Phone Number________________ Email____________________
2. __________________________________Phone Number________________ Email____________________
Signature:___________________________
Date:_____________________
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