Client Name *

First

Last

Phone *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Pet Information

How many pets will you be boarding? *

One
Two
Three

Would you like to board your pets together or separately? *

Together
Separate

First Pet

First Pet's Name *

First Pet's Species *

Dog
Cat
Other

First Pet - If other, please specify: *

First Pet - What food will your pet be eating during their stay with us? *

Own Food
Kennel Food

First Pet - Food Amount: *

First Pet - Feeding Frequency: *

1x daily
2x daily
Free feed

First Pet - AM or PM? *

AM
PM

First Pet - Special Feeding Requirements?

First Pet - I am leaving the following articles with my pet: (Due to limited space, please limit to no more than 3 items)

First Pet - If other, please specify: *

Second Pet

Second Pet's Name *

Second Pet's Species *

Dog
Cat
Other

Second Pet - If other, please specify: *

Second Pet - What food will your pet be eating during their stay with us? *

Own Food
Kennel Food

Second Pet - Food Amount: *

Second Pet - Feeding Frequency: *

1x daily
2x daily
Free feed

Second Pet - AM or PM? *

AM
PM

Second Pet - Special Feeding Requirements?

Second Pet - I am leaving the following articles with my pet: (Due to limited space, please limit to no more than 3 items)

Second Pet - If other, please specify: *

Third Pet

Third Pet's Name *

Third Pet's Species *

Dog
Cat
Other

Third Pet - If other, please specify: *

Third Pet - What food will your pet be eating during their stay with us? *

Own Food
Kennel Food

Third Pet - Food Amount: *

Third Pet - Feeding Frequency: *

1x daily
2x daily
Free feed

Third Pet - AM or PM? *

AM
PM

Third Pet - Special Feeding Requirements?

Third Pet - I am leaving the following articles with my pet: (Due to limited space, please limit to no more than 3 items)

Third Pet - If other, please specify: *

Anything you would like to add?

Please specify any additional services you wish us to provide to your pets:

Nail trim
Express Anal Sacs
Physical Exam

Please specify: *

Thank you for boarding your pet(s) at our facility, where we have our boarders’ health and comfort in mind. For the health of your pet and other borders, we are required to administer any out-of-date vaccinations before your pet’s stay. Please provide proof of vaccinations if vaccinations were obtained elsewhere. If vaccines are needed, you will be charged our standard fee for this service.

In order to maintain a flea-free environment and for the comfort of all pets staying with us, your pet will be checked for fleas and treated, if necessary, with a safe, effective, widely used EPA-approved pesticide.

I authorize this hospital to perform the procedures listed above and, in the event of an emergency, any medical or surgical procedures necessary to my pet's health and immediate well-being. I agree to pay in full for my pet’s boarding and emergency and/or requested medical care at the time of discharge. *

I have read and understand

I agree to the administration of anti-anxiety medication when deemed necessary by a veterinarian during my pets’ boarding. *

I have read and understand

I certify that I am the owner or the owner’s authorized agent for this pet. *

I have read and understand

I understand that in the event of a hurricane warning, I will be responsible for making arrangements for my pet(s) to be picked up due to Northwood Hills Animal Hospital no longer offering boarding during hurricanes. *