Bay Animal Hospital Boarding Registration

Pet’s Name ______Owner’s First & Last Name ______

IF you are boarding MULTIPLE PETS, can they board in the same accommodations? YES / NO

*For pet’s safety, roommates may be separated during their stay if needed.

Type of Food / How much per feeding? / Last Time
Pet Ate / Office Use Only
CCS / Office Use Only
Technician
OWN FOOD
Name of pet’s diet:
______
______/ ______cup(s)
______can(s)
1x - 2x - 3x / day / AM / PM

I DID NOT BRING MY PET’S REGULAR DIET AND AUTHORIZE HE/SHE BE FED BAY ANIMAL HOSPITAL’S IN HOUSE DIET (Purina EN Maintenance)AND THE SAME FEEDING INSTRUCTIONS AS ABOVE APPLY.

Does your pet require medication during their stay? YES / NO

IF YES, please list on BACK of this form.

**All medications must be in original container and labeled appropriately to whom it belongs. If needed, please ask front desk for assistance.

Does your pet have any special needs?

Dog/Cat/People Aggressive Food Allergies

Blind/DeafNeck/Back Issues

Senior PetDiabetic

Other: ______

______

Additional Services During Stay:

**Additional forms may apply.

Doctor’s Exam- $56 Nail Trim- $16/$18Bath

Prescription Refill: ______

Vaccines: ______

Estimated Pick up:

Date: ______/ Time: ______AM/PM

Phone Number(s) where we can contact you: ______, ______

Emergency Contact: Name ______Phone # ______

In the event of an emergency and you or your representative are unavailable – Please initial one:

_____ Do whatever is medically necessary for the health and well-being of my pet; I accept financial responsibility.

_____ Render only what you deem minimally necessary for the life of my pet; I accept financial responsibility.

Please see reverse side of page 

Please List All Medications Below:

Name of Medication
and Dosage (MG, ML) / Quantity / Times per day? / Last time RX was
Administered?
1x 2x 3x 4x
1x 2x 3x 4x
1x 2x 3x 4x
1x 2x 3x 4x
1x 2x 3x 4x
1x 2x 3x 4x

Please note our office hours:

Monday – Thursday: 7:30 am – 8:00 pm

Friday: 7:30 am – 6:00 pm

Saturday: 7:30 am – 4:00 pm

Sunday: 9:00 am – 12:00 pm

*Doctors are NOT on premises until 8:30 am.

Please arrive AT LEAST 30 minutes before closing for pick up.

Pets not picked up by NOON will incur a charge of an additional night of boarding unless pet is receiving a bath that day.

If your pet is scheduled for a bath before they go home, a Client Care Specialist will call you when your pet is ready for pick up.

I understand the nature of boarding services provided by Bay Animal Hospital (BAH) and the costs associated with the services I have requested. I further confirm that all the information I have provided above are correct to my knowledge and signing this form grants authorization for BAH to fulfill the needs specified on this form. I also understand that BAH does not recommend any personal items to be kept in the boarding enclosure with the pet as they may get damaged or lost and BAH does not assume responsibility for these items (this includes beds, blankets, toys, collars/leashes, clothes, chews or toys.) I understand that rawhide chews and pet toys may present choking hazards for pets and therefore BAH does not allow these items to be left with pet unattended. Continuous presence of BAH personnel is not routinely provided during non-business hours, but fresh water, food and freshly laundered blankets and towels are provided every day when safe to do. Cat litter is scooped twice daily and dogs are walked at least 3-4 times daily or as needed.

Signature ______Date ______

Office Use Only:CCS Checking In: ______Technician: ______