Client Information

Owner's First Name*

Owner's Last Name*

Owner's Email Address*

Home Phone Number*

Work Phone Number

Cell Phone Number

Street Address*

City *

State*

Zip code*

​​​​​​​​​​​​Pet Information

Pet's Name*

Pet's Breed*

Pet's Weight

New Boarder

Second Pet's Name

Second Pet's Breed

Second Pet's Weight

Second Pet's New Boarder

​​​​​​​Date of Boarding

Drop off date *

Drop off time *

Pick up date *

Pick up time*

*Note: Please call to confirm drop off and pickup times and boarding availability.

​​​​​​​Emergency Contact Information

Additional Services

Services:

Pets that are bathed may not be available to go home until late in the day. Please call the day of check out before picking up your pet. We request that you keep your pet's collar and leashes - thank you!

*Note: Additional charges apply for these services.
​​​​​​​

Medications and Special Instructions

Please list special conditions, medications, dosage, frequency, last given, brought meds, etc.

Please list any medical conditions we should be aware of

All dogs must have the Bordatella, Canine Influenza, Rabies, and Distemper vaccines and a current negative fecal sample in order to board at BRAH. All cats must have the Rabies and Feline Distemper vaccines and current negative fecal sample in order to board at BRAH.Any flea/ticks will be treated at owners expense.

My pets diet is

How often and how much do you feed?

Feeding

Other special feeding instructions/type of food

Being away from home can be a stressful experience for some pets. I give permission for treatment and assume payment if my pet becomes ill while boarding. I understand that in the unlikely event my pet becomes ill during his/her stay, my pet will be treated promptly at my expense.

I also understand that the Broad River Animal Hospital will make a reasonable effort to contact me at the above emergency phone number prior to treatment, should time permit. Also, if your pet has external/internal parasites the pet will be treated at time of admission and will be billed at the owners expense.

I Agree to the terms above:*

Owners signature of agreement