Dowlen Road Veterinary Center Boarding Form

Scheduled for space:______             Dowlen Road Veterinary Center                 Bath:  ________ Ck’d  by:________

Flea Treatment:     Yes or No (Circle One)

 

Check in date/time:___________

Check Out date/time: _________ Home Phone: ___________ Other Requested Treatments:_________

OWNER(s) Last Name: _________   First Name:______________Emergency Phone #________________

Pets Name: ________ Species/Breed:__________ Age: ____ WT_______ Client #: ____________

 

 

         

   
   
Boarding  Fees
Circle One   

Feline  (All)       $17.00

Canine:     1 –20    $17.00   

Canine     21– 40   $18.00

Canine     41– 60   $19.00   

Over  60            $21.00

   

 


 General Guideline:  Feeding Instructions    (Please circle appropriate feeding schedule per age and weight)                        Puppies and Kittens 2 x per day

Weight                Pediatric: (0-1year old)                      Adult: (1year – 7years)                     Geriatric: (over 7 years)

< 20 lbs -              ¼ to ½ cup twice per day                     1 - cup once per day                           1 -cup once per day

20 – 40 lbs -          1 cup twice per day                             1 ½ - cups once per day                     1 ½ -  cups once per day

40 – 60 lbs -            1 ½ cup twice per day                       2 - cups once per day                          2  - cups once per day

60 – 80 lbs -          ---------------------------                           2 ½ - cups once per day                     2 ½ - cups once per day

> 80 lbs -                ----------------------------                           3 - cups once per day                          3 - cups once per day

 

IF Owner  BRINGS OWN FOOD PLEASE FILL OUT THE FOLLOWING:          DID O FEED ALREADY FOR TODAY?YES/ NO

Special Food Instructions:AMOUNT:                           HOW OFTEN:                                      DESCRIBE CONTAINER:                        

MEDICATIONS:       List each Drug:     Oral meds: $1.50 per time given    Injections:$9.00-$15.00 per injection

Meds located:            

Please circle one:               ________________________       ______ times per day         Already had today:        Yes           No  

On cage/ Fridge             ________________________       ______ times per day         Already had today:        Yes           No

Or in Cubby                ________________________       ______ times per day         Already had today:        Yes           No

<<<<<<TOTAL COST PER DAY:____________________>>>>>>>>>>

EXTRA PLAY TIME: One on one personal outdoor playtime is available for your pet(s) each day with a variety of activities to choose from.

I request the following extra activities once a day, cost is $5.00 dollars per each additional activity(s) requested. (Please circle your request) 

FRISBEE             BALL TOSSING                EXTRA WALKING          HOLDING/BRUSHING         OBEDIENCE ($5.00ea)

<<<<<<TOTAL COST PER DAY:____________________>>>>>>>>>>

                        Legend:  0 – Did not     √  -  Did       NAF = No Abnormal Finding     

Payment for all services rendered is expected at the time of serviceI authorize treatment and surgery for my pet.  I understand that medicine is not an exact science and that no guarantees of medical results have been implied.  As the owner or authorized agent of my pet I hereby release Dowlen Road Veterinary Center, their agents, servants, or representatives from any and all liability arising from treatment of my pet..  I authorize the doctor to treat emergencies as deemed necessary.  We require all vaccinations to be given here.  Please do not bring anything larger than an 8” x 8” x 8” box.  We will not be held responsible for any items brought into the clinic for your pet while boarding.

Signed___________________________________________________________   Date_________________________

Employee Signature: _______________________________________________    Date:_______________________