Griffith Small Animal Hospital

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* This field is required

Owner’s Name

Pet’s Name

Contact #

Email

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* This field is required

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Scheduled By

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Examination – Wellness with / without vaccinations

($44.00 to $52.00)

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Currently taking HW Preventative?

Vaccines due?

Services to be rendered during stay

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All pets entering our boarding facility must have been vaccinated against all contagious diseases and be free from parasites (hookworms, fleas, ticks, etc.) or they will be treated upon entry or discovery at the owner’s expense.

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Kennel Bath ?

Date to be performed

Toe nail trim / Capstar / Scheduled

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***FEEDING INSTRUCTIONS***

Bringing food?

If yes, what kind and how often?

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Kind Amount Measurement Frequency

Additional Instructions

When should we feed your pet next?

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Medication

How often do we give it?

Time last given?

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Medication

How often do we give it?

Time last given?

Medication

How often do we give it?

Time last given?

Medication

How often do we give it?

Time last given?

Medication

How often do we give it?

Time last given?

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If the medication runs out during your pet’s stay, may we refill it?

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I understand that if my pet needs medication or stimulus to feed while here, I am responsible for the following that apply:

1-2 Meds $3.00 per day | Nursing Care – $5.00 to $15.00 per day | Special Diet $4.50 - $6.75

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Initial

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Your pet’s well being is our utmost concern. We will do everything in our best judgment to see that your pet is well cared for and kept in a clean and dry environment.

Boarding can be a stressful time for your pet. As an example, some pets develop diarrhea due to change of environment or diet. If this occurs we will provide appropriate medical care and the additional fees will be applied to your account.

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**Please initial one option below**

Please treat my pet for diarrhea, you do not need to contact me.

Please contact me prior to any procedures/treatment for diarrhea.

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In the event of a health concern and/or emergency the staff of Griffith Small Animal Hospital will make every effort to get in touch with you or your designated emergency contact prior to any procedure(s) being performed; but treatment for a life threatening emergency will not be withheld if contact is not made. In the event you cannot be reached:

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**Please initial one option below**

I authorize Griffith Small Animal Hospital to do whatever is necessary, I understand that I am responsible for any additional charges incurred.

I authorize necessary procedures/expenses up to $( Mention below ) beyond standard boarding charges.

Please do not render any treatment to my pet until I can be reached.

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Please mention amount

$

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Signature

Clear

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Date

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DATES OF STAY* This field is required

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Comments

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Any potential problems or abnormalities noted by the kennel staff are immediately reported to a doctor or technician for further evaluation.

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Appetite

Your pet ate and drank normally during his/her stay.

Your pet did not eat or drink normally.

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Elimination

Your pet had normal stools and urine during his visit.

Your pet had abnormal stools or urine.

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Medication

No medications were given during your pet’s visit.

Your pet took all of his/her medications with no problems.

We gave your pet additional medications:

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Date(s)

Medication

For

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Other Comments

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Thank you for entrusting your pet’s care to Griffith Small Animal Hospital

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