Owner Name*Pet Name*As the owner or authorized guardian of this animal, I give my permission to the clinic to receive, treat, prescribe or otherwise care for the animal above as deemed necessary. 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 clearance.If my pet becomes anxious while boarding, I give my permission to administer a mild relaxing sedative.* Yes No I understand that if fleas or ticks are seen on my pet, a topical treatment will be applied.Last flea & tick product used:Date applied: MM slash DD slash YYYY I have labeled all personal items brought with my pet. Please list all items:Emergency Contact* First Last Phone*Feeding amount:Feeding frequency:Time of last feeding:Medication name:Instructions:Time of last dose:Medication name:Instructions:Time of last dose:Medication name:Instructions:Time of last dose:Is your pet having any special problems?Additional services requested for my pet while boarding: Bath Nail Trim Anal Sac Expression Clip Mats Ear Cleaning Other additional services requested:Date of Pickup MM slash DD slash YYYY Time of PickupElectronic Signature*Electronic SignatureDate* MM slash DD slash YYYY Date
