Express Boarding Check-In Form - Steinbach Veterinary Hospital

Client Information

Client Name *

Address *

Telephone *

Patient Name *

Species *

Dog

Cat

Other

Breed *

Sex *

Male

Male Neutered

Female

Female Spayed

DOB

Boarding Information:

Date of Drop off *

Date of Pick up *

Would you like a paid bath for your pet? *

Yes (Additional Fee)

No

Note: All pets that are not getting a paid bath will get a complimentary clean up on the date of pick up unless specified by the owner that they do not want this service for their pet.

Feeding Instructions:

Our in-house diets are Hill’s Science diet for sensitive skin and stomach (dry) and Canned Purina ProPlan. We can feed your pet either one of the two or a mixture of dry and canned

How will we be feeding your pet? *

In-house diet

I will be bringing my pets own food

If bringing your pets own food, please describe the feeding instructions in detail

Note: All food is to be labeled with your pet’s first and last name with a permanent marker. If possible we would prefer all dry food be pre bagged individually.

Food Brand

How many individual bags of food will you bring in?

How many cans of wet food will you bring?

Medical Information:

Note: ***All medications must be in original prescribed bottles with drug name and quantity of how many pills are left in there at the time of drop off***

Medications brought from home:

Name of Medication(s)

Strength

Dosage

Date/Time of last dose before drop off

Have you noticed any of the following over the last week?
***If sick exam will be at the owner's expense and if further treatment is recommended will need owner’s permission***

Vomiting *

Yes

No

Diarrhea *

Yes

No

Coughing *

Yes

No

Sneezing *

Yes

No

Limping *

Yes

No

Loss of Appetite *

Yes

No

Increased Appetite *

Yes

No

Other

Does your pet have any special emotional needs that we should be aware of?

Emergency Contacts *

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