"*" indicates required fields Pet's Name* Client's Name* Client's Phone Number*Boarding DateCheck In Date* MM slash DD slash YYYY Check Out Date* MM slash DD slash YYYY Check In Time* Hours : Minutes AM PM AM/PM Feeding InstructionsFeeding Instructions* Please feed kennel food Other What kind of food?* Wet Food Dry Food How much food?*How often?* AM Mid PM Medication InstructionsMedication InstructionsName of MedicationDosing InstructionsHow often given?Last given (Day/Time) Add RemoveVaccinations and Preventative TestingThe proof is required if vaccines are current. A current wellness exam is required to board. (*Required to board.)Species?* Canine Feline Fecal Exam ($35.00) I accept Current I decline Product NameRabies ($30.00)* I accept Current FVRCP ($31.00)* I accept Current FeLV ($36.00) I accept Current I decline Rabies ($24.00)* I accept Current DAPP ($30.00)* I accept Current Bordetella ($27.00)* I accept Current Canine Influenza* I accept Current Leptospirosis ($25.00) I accept Current I decline Heartworm Test ($57.00) I accept Current I decline Additional ServicesOption Nail Trim Anal Gland Expression Playtime (price per day basis) This is an extra 20 minutes of outside playtime with our Animal Care Attendants throughout the day. Your dog will get an extra 10 minutes outside in the morning, and again in the evening Medical Illness PolicyOne of the advantages of boarding at a veterinary clinic is that veterinary attention is readily available should the need arise. If your pet becomes ill we will call the contact number you leave with us regarding your pet’s symptoms, treatment options, and estimate of additional costs. However, if no one can be reached please indicate your approval below should your pet require treatment to relieve immediate discomfort or to resolve an important medical condition. Piper Heritage Veterinary Clinic has my permission to do whatever is necessary should the need for medical care arise. I authorize up to: Do not administer any medical treatment until specific authorization is given. Amount authorized in medical care for my pet until someone can be reached* $100 $200 Other SignaturePrimary Phone NumberSecondary Phone NumberAuthorized Agent Name to Pick Up Pet (If Owner Will Not Be Picking Up)Authorized Agent Phone NumberEmailThis field is for validation purposes and should be left unchanged.
