Boarding Admission and Drop Off Form in Kilgore, TX

"*" indicates required fields

Name*

Phone*

Email*

Pet Name*

Date of Admission*

1. All pets boarding must be current on vaccinations. Written proof of vaccinations or verification with the pet's veterinarian must be provided before boarding the pet(s).

2. All patients will be closing a Capstar/Advantus at admission. If additional parasites are found on the pet during it's stay, they will be treated as The Clinic determines, and the cost of the treatment will be added to the total bill.

3. If the pet is to be picked up by someone other than the owner, please let us know by leaving that information below

Name (Proxy)

Phone (Proxy)

4. All reasonable precautions will be used to prevent injury and escape of the pet. The Clinic is not responsible for the actions of the pet that may cause injury and escape.

5. All pets not picked up within 7days after the expected date of pickup will be considered abandoned. The Clinic is given authorization to dispose of the pet(s) as they deem best, including euthanasia.

6. If your pet experiences more than average anxiety from boarding, we will medicate your pet accordingly

Emergency Contact Name and Phone Number

*** IN THE EVENT THAT I CAN NOT BE REACHED ***

Emergency Contact Name*

Emergency Contact Phone Number*

Actions to proceed by the clinic*

Treat my pet as needed. Do any and all diagnostic test, treatments, and surgeries necessary for the well-being of my pet. I accept full financial responsibility for all charges related to the treatment of my pet(s).

I request that no treatment be performed. I agree that NCAH is not liable for any consequences of this decision.

North Creek Animal Hospital is not responsible for any damaged or lost items brought into Clinic with pets

Instructions

Name of Medication

Amount Given

What Time

Is your pet sensitive or allergic to any medications or food?*

Yes

If yes, please list*

Please describe the problem(s) your pet is having, pertinent history leading up to the current condition, any previous major medical problems, and what you would like us to do below:

Would you like us to:

Treat your pet after examination

Call you with findings of the examination and an estimate of treatment cost prior to treating your pet

Bath Request*

I request a bath

I decline a bath

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PERFORMED

Signature*

Comments

This field is for validation purposes and should be left unchanged.

North Creek Animal Hospital

Boarding Admission and Drop Off Form

Emergency Contact Name and Phone Number

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