Boarding Consent - Eastern Shore Animal Hospital

Owner Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Pet Name*

Species*

Breed*

Sex*

Male
Female

Color*

Weight*

Patient Alerts

Allergies?

Medical Alerts?

Non-Medical Alerts?

Special Diet?

Temperament?

Vaccine Reactions?

Behavioral Notifications

Please check the box if applicable.

My pet has a history of cage aggression.
My pet has a history of food aggression.
My pet has a history of dog aggression.

Pet Information

Last flea & tick product used:

Date applied:

Personal items:

What food is typically fed at home?

What is being fed while boarding?

Feeding instructions:

Medication history:

Other medications or supplements:

Special instructions for your pet?

Additional services requested for my pet while boarding:

Call for prices.

Bath
Nail Trim
Anal Sac Expression
Ear Cleaning
Other

Other additional services requested:

Date of Pickup*

Time of Pickup*

If my pet becomes anxious while boarding, I give my permission for an anti-anxiety/calming medication to be administered.

Yes, I consent.

Flea/Tick*

I understand that if fleas/ticks are seen on my pet, a treatment will be applied to my pet at my expense.

I understand that if I provide Eastern Shore Animal Hospital with medication(s) for my pet, all must be in the original bottles for identification purposes.*

Yes, I understand.

I understand that my pet is required to be up to date on all vaccinations in order to be boarded, further more I have provided proof of vaccinations prior to today's boarding reservation. Eastern Shore Animal Hospital reserves the right to deny boarding to any pet not up to date on it's vaccinations for the health and safety of our team and our patients.*

Yes, I understand.

Emergency Contact*

First Last

Phone*

Electronic Signature

Date*
MM slash DD slash YYYY

Date

Boarding Consent Form

Patient Alerts

Pet Information