Boarding Pre Check-In Form

Client Name*

Pets Name*

Check in notes:*

Late Check Out?
Grooming?
Vet Appointment? (convenience care sheet completed)

Medications
None

Medication Name	Dosage

Food*

Own Food
Clinic Food

How much/ How often*

Belongings

Collar*

Lead*

Toys*

Blanket*

Bed*

Are the required vaccines/tests current?*

Yes

No

Dogs: Rabies vaccine, Distemper / Parvo vaccine, annual Bordatella vaccine, Canine Influenza vaccine, annual stool check, and annual Heartworm test

Cats: Rabies vaccine, FRCP vaccine, Leukemia vaccine or FELV test and annual stool check

What flea prevention do you use?*

Nexgard

Simparica

Last given?*

Please note: Your pet will be checked for fleas upon arrival, if fleas are noted, your pet will be treated at your expense*
I give my permission for my pet to have peanut butter filled kongs and other “busy” toys provided by Paw Pur’s Place during their stay.

Yes

No

Is your pet healthy today?*

Yes

No

Does your pet have any of the following symptoms?*
Coughing
Sneezing
Vomiting
Diarrhea
Changes in appetite or water consumption
Seizures
Red Skin
Flaky Skin
Dry Skin
Scabs
Ears: Red
Ears: Discharge
Ears: Odor

Other - please list*

Does your pet show cage aggression?*

Yes

No

Does your pet have aggressive tendencies toward other dogs and/or people?*

Yes

No

If yes, please explain*

Has your pet bitten anyone?*

Yes

No

If yes, please explain*

Should injury or circumstance warrant the need for emergency service, I understand that the clinic will try to contact the necessary people before treatment, but will exercise the option to proceed if no one is available for approval.

Emergency Contact Name*

Phone*

Emergency Contact Name*

Phone*

MCAH*

Authorized Pick up person*

Phone*

Our Address

Hours

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Boarding Pre Check-In Form

Our Address

Hours

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