Palisades Veterinary Hospital - Exotic Boarding Registration

1
* This field is required.
2
Client’s name
Pet’s name
Client account number
Species
3
Please bring your pet’s cage, food, treats and bedding.
Toys or personal belongings
Does your pet have any behavioral or medical problems we should be aware of?
Who is your pet’s regular Veterinarian?
4
Emergency contact
Emergency phone
Person other than owner authorized to pick pet up from boarding
Diet (Own food)
AM
PM
Other
Feeding Schedule
5
If other, please explain
6
Yes
No
Did your pet eat today before arriving?
Medication/Supplements to be given while boarding
Yes
No
Did your pet get their medication today?
Nail trim
Beak Trim
Wing Trim
Other
Veterinary Services
7
If other, please specify
8
I agree to and understand this policy.Permission to treat: Should my pet(s) become ill, a Palisades Veterinary Hospital veterinarian may provide all medical and surgical treatment deemed necessary in the doctor’s professional judgment. I acknowledge that in the event of my pet’s illness, the Palisades Veterinary Hospital staff may not be able to contact me immediately and is therefore authorized to initiate appropriate treatment until I (or the pet’s agent) can be reached. I agree to pay all related expenses associated with treatment of my pet until I am available to discuss further care and related fees with the attending veterinarian. If my dog has a serious illness or injury that becomes critical during my absence, I want the doctors to
Resuscitate my pet
Do not resuscitate my pet
Please specify
(Client initials)
9
Owner’s signature* This field is required.
Clear
10
Date
Date
Year
Month
Day
Should be Empty: