Boarding Check-In Form

Client Name*
Pets Name*
Are the requirements listed below 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?*
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
Do you wish for your pet to be seen by the Veterinarian while here?
(If yes, the Urgent Care sheet found on the website needs to be filled out by client)
- Yes
- No
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 #*
Regular Veterinarian Contact Info
Signature*
As the owner or authorized guardian of this animal, I give permission to MCAH to receive, treat, prescribe or otherwise care for the animal above as deemed necessary.
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Boarding Check-In Form

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