South Point Pet Hospital



[pic] South Point Pet Hospital ` [pic]

#108 2828 152nd Street, Surrey B.C.

604-531-8222

EXCLUSIVELY FELINE LUXURY CAT BOARDING

ADMISSION FORM

Owner's Name ________________________________ Pet's Name _________________________

Boarding Dates: Drop Off ______________________ Luxury Suite: _______________________

Pick Up _______________________

FVRCP vaccine up to date? ______________ (Staff member initials)

*If vaccines have been given elsewhere proof of vaccination will be required prior to drop off*

• Is your cat currently on a monthly flea medication? Yes _____ No _____

- If "No", a single dose of Advantage flea control will be applied in clinic ($17.98)

- If your cat currently has fleas, a dose of Capstar flea treatment will be administered ($5.00)

• Has your cat recently experienced any of the following?:

Vomiting _____ Diarrhea _____ Coughing _____ Sneezing _____

• Is your cat allergic to any food or medication? _______________________________________

• Has your cat had any injury or illness in the last 30 days? ______________________________

• Is your cat on any medication? Please specify dosing instructions. _______________________

____________________________________________________________________________

____________________________________________________________________________

• Current diet and feeding instructions: ______________________________________________

____________________________________________________________________________

____________________________________________________________________________

I understand that in the event of an illness/emergency the staff will contact me or my emergency contact to discuss the problem and treatment options. If the staff is unable to contact anybody I authorize South Point Pet Hospital to initiate appropriate treatment.

I will contact South Point Pet Hospital as soon as possible if my pick-up date changes. If I neglect to pick up my pet within seven (7) days of the scheduled pick-up date without notification, you may assume that I have abandoned my pet and have forfeited all legal rights to my pet, thereby authorizing South Point Pet Hospital to deal with my pet as they see fit.

I understand that the hospital is not responsible for loss or damage to personal items left with the pet including but not limited to leashes, collars, toys, and bedding.

I have read the above terms and conditions.

Client Signature _________________________

In case of emergency I can be reached at: _________________________

If I am not available please contact:

Name: _________________________ Phone: _________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download