Boarding Check in Form

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Contact Name

Contact Phone Number

Contact Email Address

Contact Address

Contact Address 2

City

State / Province / Region

ZIP / Postal Code

Pet's Name

Pet Birthdate

Pet Species & Breed

Pet Breed

Sex

DROP OFF DATE

PICK UP DATE

Pick up time of day

AM PM

CAT OWNERS

Current on all required vaccines?

Yes No

Rabies, FVRCP, Bordetella FELV

DOG OWNERS

Current on all required vaccines?

Yes No

Rabies, Distemper, Bordetella, Influenza Lepto, HWT, Fecal

MEDICATIONS

I understand that my pet must be current on all vaccinations required by TPAC prior to boarding. If proof of vaccines are not presented at the time of boarding, the vaccines will be given and I will be charged for these services. If parasites are found they will be treated while boarding.

Food

How often

How much

What type

Food Allergies

Yes No

ITEMS BROUGHT

PLEASE BE AWARE OF THESE PROBLEMS

If my pet becomes ill or an emergency arises, I understand Tazewell Pike Animal Clinic will perform diagnostics and treatment medically necessary for the health and comfort of my pet during their boarding. We will try to contact you, if unable to reach you, we will still treat your animal

Signature:

Date

Boarding Check In Form

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