Medical Boarding Form

Name: Veterinarian
Brand: Southport Veterinary Center

Today's Date

Pick up date

Approximate Time

Owner Name

Contact Email

Pet(s) Name

Bath

Yes

Medication

Yes

*There will be an extra charge of $15.00 per day for the administration of medication.

Person(s) to contact in case of emergency

Emergency Phone Number(s)

Our Vaccination Policy: To insure the protection of all pets under our care, the following vaccinations must be up to date:
Dogs: DHPP/ (DISTEMPER), RABIES, BORDETELLA (Kennel Cough)
CATS: FVRCP (DISTEMPER), RABIES

I give my permission for the Southport Veterinary Center to update my pet's vaccinations in accordance with the above policy

I understand that my pet will be treated for fleas at my expense of $15 if fleas are found

I would like to be notified if charges exceed 15% of the signed estimate

Medical Illness Policy: One of the advantages of boarding your pet at a Veterinary Hospital is that Veterinary attention is readily available should the need arise. If one of your pets become ill, we will call the emergency number listed above regarding your pets' symptoms, treatment options, and estimate of additional costs. If no one can be reached, however, please indicate your wishes below should your pet require treatment to relieve immediate discomfort or to resolve an important medical condition.

Please perform whatever services the doctor deems necessary for the best care of my pet until someone can be reached. This includes only non-elective treatments and any necessary diagnostics.

Do not administer any medical treatment until specific authorization is given. I fully intend to pick up my pet on the date specified. If circumstances change, I will notify the hospital.

Signature

Sign above

BOARDING FEES MUST BE PAID IN FULL WHEN PET IS PICKED UP

Feeding

Please write feeding instructions below and when the next meal is due.

Medications

Please write the medication directions and when they need to be given next. If they are not on any meds, please write so and sign below.

Personal Items

Please list any personal items that you are bringing in for your pet (i.e. toys, blankets, beds)

Signature

Sign above

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Medical Boarding Form

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