Drop Off Date: *

Date of pick-up: *

Pick-up Time: *

AM
PM

(Note: Pick ups are available the following days/times: Monday-Friday 8am -6pm, Saturday 8am-2pm and Sunday 5pm-7 pm)

Owner: *

Veterinarian: (if other)

Please list all Medications: *

Pet: (name, breed, color) *

Allergies? *

Yes
No

if yes, explain:

Aggression issues? *

Yes
No

if yes, explain:

Incontinence issues? *

Yes
No

if yes, explain:

Will you be bringing food for your pet? *

Yes
No

Please provide feeding instructions *

Can you pet have treats while in our care? *

Yes
No

EMERGENCY CONTACTS: *

COUNTRY VIEW VETERINARY SERVICE BOARDING HEALTH POLICY

To insure the protection of all pets under our care, the following must be up-to-date:

Dogs:

Exam (annual), Rabies, DHPP, Bordetella (annual), Influenza, Fecal (6 months)

Cats:

Exam (annual), Rabies, RCP, Fecal (6 months)

I give permission to update my pet(s) vaccination, fecal parasite evaluation and treatment, flea preventive and annual (initial) physical examination in accordance with the above policy if proof of treatment cannot be verified. I accept full responsibility for any charges incurred. *

I agree

Flea/Tick Preventive

(If fleas/ticks are noted on arrival, a medicated bath will be administered)

Product Name:

Date of Application:

Social Media Release

Country View Veterinary Service hereby has permission to use any photos taken of your pet(s) during boarding for advertising purposes and social media. Pet’s Name(s) will be used. Last names or names of owner(s) will not be released.

I WISH TO DECLINE Country View taking photos of my pet(s). Please sign here

Clear Signature

Illness/Injury Policy

Country View Veterinary Service and its employees are not responsible for fees incurred should a pet become ill or injured during their stay. *Please note that an exam may be performed in the event your pet becomes ill or injured and needs to be treated by one of our veterinarians. In the unlikely event that your pet has a life-threatening event during their stay, we will perform life-saving measures while we attempt to contact you unless declined below.

Please Check One: *

Please perform all recommended medical services.
I authorize up to $100 in medical care for my pet(s) until someone can be reached.
I authorize up to $300 in medical care for my pet(s) until someone can be reached.
I authorize an amount greater than $300 in medical care for my pet(s) until someone can be reached.

Amount that you authroize: (greater than $300) *

I have read and understand this agreement.

Owner/Agent for Pet(s): *

Clear Signature

Date: *

Boarding Check-In and Consent Form

COUNTRY VIEW VETERINARY SERVICE BOARDING HEALTH POLICY

Dogs:

Cats:

Flea/Tick Preventive

Social Media Release

Illness/Injury Policy

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