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Southwind Animal Hospital
7910 Winchester Rd.
Memphis, TN 38125-2307
901 362-8321
Boarding
Consent Form
Revised
6/05
Name
______________________________ Today’s Date __________
Pet’s Name
_____________________ Pick-up Date __________
Pick-up Time
__________
LIST ANY ADDITIONAL SERVICES
NEEDED WHILE HERE:
(bathing, grooming,
vaccinations, etc.)
1. _________________________ 3.
_________________________
2. _________________________ 4.
_________________________
PLAYTIME (per day)
NONE _____ ONE _____ TWO _____
Your pet can have up to two
playtimes daily Monday-Friday and one on Saturday. Each playtime lasts for
10 minutes and is an additional charge of $6.25.
MEDICATIONS
(List each medication and dosage. Let
assistant know if pet has had today’s dose.)
1. _________________________ 3.
_________________________
2. _________________________ 4.
_________________________
There is an additional
charge of $3.50-$6.00 for each administration.
SPECIAL DIET
___________________________________________
There is an additional
charge for any special diet unless you bring your own food. Eukanuba Low
Residue is fed during your pet’s stay unless otherwise specified.
FEEDING INSTRUCTIONS
________________________________
ITEMS LEFT
______________________________ Please limit to 2.
We are not responsible for
any items left.
PLEASE
NOTE:
PETS MUST BE CURRENT ON VACCINATIONS BEFORE BEING ADMITTED
TO THE KENNEL. IF VACCINATIONS CANNOT BE VERIFIED, YOUR PET WILL BE
VACCINATED UPON ADMISSION. ANY PETS WITH FLEAS AND/OR TICKS AT THE TIME OF
ADMISSION WILL BE TREATED AT THE OWNERS EXPENSE.
I have read and
understand the above. If my pet becomes sick while boarding I give
Southwind Animal Hospital to administer necessary treatment at my expense.
Signature
______________________________ Date _______________
EMERGENCY NUMBER ________________ Ask for _____________
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