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Boarding Agreement Form

Patient Name:

Arrival Date:

Departure Date:

Weight:

Checked in by:

Arrival Time:

Est. Time of P/U (after 11 am):

Contact Number:

Feeding Instructions:

Feeding Instructions:
A
B
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Type/container:

-or-
Instructions: (i.e. 1 cup BID, mix wet food, etc.)

Belongings:

Belongings:
A
B
*PPHC is not responsible for any lost or damaged items that are left with your pet*

Extra Playtime:

Extra Playtime:
A
B

Medications:

Medications:
A
B

Name/mg of medication

Administration instructions

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Name/mg of medication

Administration instructions

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Name/mg of medication

Administration instructions

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Name/mg of medication

Administration instructions

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**All pets MUST have proof of current vaccinations before being left at our clinic or we will vaccinate them for you**

Canine Vaccines:

Exam
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Rabies*
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DHPP*
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Bordetella*
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Fecal*
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Flu (Bivalent)*
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ABC
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HW occult
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Proheart inj.
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Lepto
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Feline Vaccines:

Exam
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Rabies*
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FVRCP*
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Fecal
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ABC
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HW Occult
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Leukemia
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*Required by boarding

Vaccine/testing to be done by

Vaccine/testing to be done by
A
B
*Technicians can ONLY do fecal, heartworm, and bloodwork testing can ONLY administer the bordetella, lepta, and flu vaccines. Your pet MUST have been seen by a doctor within the past 11 months in order for a technician to give these particular vaccines or do testing*

Additional services needed:

Additional services needed:
A
B
If yes, explain.

In the event of an emergency,

In the event of an emergency,
A
B

Minor Issue:

Minor Issue:
A
B
*Bathing is free for ALL dogs staying more than one night. Nail trims are not included, but can be added on for an additional fee*
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*Charges for services and medication are due upon receipt of the invoice. Payment can be made by cash, check, or credit card. If you neglect to pick up your pet within 5 days of the above date, we will assume that the pet has been abandoned and we are hereby authorized to supervise the pet’s needs as we deem necessary.*

Signature:

Signature

Date: