BOARDING CHECK-IN FORM

(To be filled out on the day of check-in)  

back to Forms Page

Please print this form, fill it out and bring it with you to your appointment.
Owner(s)________________________________________________________________________________________
Date In__________________ Date Out___________________ Approx. Pick-Up Time___________________________
I/We can be reached at_______________ In case of emergency, please call (local)_______________at_____________
Will someone other than you be picking up your cat?  qYes   qNo       If "Yes", who?_____________________________

If yes, payment arrangements will need to be made in advance.
  Cat #1____________________ Cat #2_____________________
Check if happened within the last 48 hours:

 q Sneezing    q Coughing   q Runny Eyes               q Vomiting    q Diarrhea

q Sneezing       q Coughing      q Runny Eyes               q Vomiting    q Diarrhea
If checked, please explain: _________________________ __________________________
_________________________ __________________________
Has your cat been treated for fleas in the last 30 days? qYes   q No qYes   q No
Food Preferences:
q Dry Friskies   q Science Diet Light
q Science Diet Maintenance
q Other (supplied or paid for by owner)
     Canned:_________________________
     Dry:____________________________
     Treats:__________________________
q Dry Friskies   q Science Diet Light
q Science Diet Maintenance
q Other (supplied or paid for by owner)
     Canned:_________________________
     Dry:____________________________
     Treats:__________________________
Are there medications from home?* qYes   q No qYes   q No
If yes, when was last dose given: _________________________ _________________________
Please list doses and frequency for each medication _________________________ _________________________
   *($1 fee is charged each time medications are given)  
Special Instructions: _________________________ _________________________
  _________________________ _________________________
Kitty Inventory* (toys, blankets, etc.)

(*must be labeled with owner's last name)

 _________________________ _________________________
_________________________ _________________________
Would you like you r cat to receive a complimentary nail trim?  qYes   q No  qYes   q No

FOR YOUR CAT'S HEALTH
To ensure the protection of all cats under our care: If fleas are found, a flea treatment will be applied. If your cat develops or comes in with syptoms suggestive of infectious disease, an immediate physical examination, apprpriate medication and isolation will be arranged at our doctor's discretion.  If your cat does not eat, for two consecutive days, an appetite stimulant will be given on the third day. Charges for these services will be added to your bill.  Further care will be addressed according to your wishes below.

OUR MEDICAL ILLNESS POLICY
If your cat(s) becomes ill, we will call the emergency numbers you have listed on this form regarding your cat's symptoms, treatment options, and estimate of additional costs. However if we cannot reach anyone, please choose one of the options listed below to indicate your wishes.
Until someone can be reached, I authorize up to (check one):

q $100  q $250 q Perform whatever services the doctor deems necessary.
(This includes only non-elective treatments and any necessary diagnostics.)
I intend to pick up my cat(s) on the above date specified. If circumstances change, I will notify the hospital of a new pick-up date.  I understand my cat(s) may have to move to Hospital Boarding if there are no Pampered Boarding vacancies available beyond my reservation time.

Owner or Agent for Cat(s) __________________________________________________________                             Date_________________