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Up Front Guest Release Form

Client Name

Staff Initials

Client Address

Pet's Name

Breed

Color

Arrival Date

Departure Date

Contact phone #

Primary contact person

Emergency Phone #

Emergency contact person

Contact email

Should a medical issue arise, would you like to be called before treatment is given?

Should a medical issue arise, would you like to be called before treatment is given?
A
B
*We will make every attempt to contact you however treatment will be started immediately if we are unable to make contact and is deemed necessary by a veterinarian.

Does your pet have a special diet?

Is your pet on any medication?

Is your pet on any medication?
A
B

Medication(s)

Did you bring medication?

Did you bring medication?
A
B

Medication(s)

How much?

*IF OWN MEDICATION IS BROUGHT PLEASE FILL OUT PAGE 2

Special instructions

I understand that all vaccinations for my pet must be current before boarding, including, for dogs, the Leptospirosis vaccine and Canine Influenza vaccine. All basic lab tests, such as a stool analysis and heartworm tests, must also be current. For the safety and well-being of all of our guests WE CANNOT MAKE ANY EXCEPTIONS TO THIS POLICY.
I give permission to perform such tests and administer vaccines if needed, and understand that I will be charged accordingly. I'm aware that, in order to board, my pet must have been examined within the past six months by a West Hill's veterinarian. WEST HILLS IS NOT RESPONSIBLE FOR PERSONAL ITEMS LEFT WITH YOUR PET!

Please indicate whether you wish your pet to be fed in the evening on the day of departure.

Please indicate whether you wish your pet to be fed in the evening on the day of departure.
A
B

BATH REQUESTED? ( An additional fee according to pets size will apply ranging from $50-85, spa packages will be an additional $15 to the bath rate)

BATH REQUESTED? ( An additional fee according to pets size will apply ranging from $50-85, spa packages will be an additional $15 to the bath rate)
A
B

Do we have permission to bathe if needed?

Do we have permission to bathe if needed?
A
B

Will you be picking up before 12 noon?

Will you be picking up before 12 noon?
A
B

Do you need any

Do you need any
A
B
C
D
E
Please call the hospital ahead of time if you will arrive after regular hours. We also appreciate notification if your pets stay will be extended beyond the date indicated.
PLEASE BE ADVISED PATIENTS/OR GUESTS WHO ARE NOT PICKED UP BY 10:00PM WILL INCUR AN ADDITIONAL NIGHTS FEE.

Signature of Owner or Authorized Agent

Signature

Date