Lodging Information Form - Country Friends Veterinary Clinic

Today's Date(Required)

Email(Required)

Phone(Required)

Patient's Name(Required)

Check-In Date(Required)

Check-Out Date(Required)

Please provide the following details so that we can provide desired accommodations:

If yes, what over the counter and or prescription medications are required and how often are they administered?(Required)

If yes, what is the brand of food you will be bringing?(Required)

If yes, how much do you feed your pet?

Cup

Scoop

Can

If yes, please list any other food additions and how much here. Examples are cottage cheese or green beans.(Required)

If yes, please provide details of the allergies:(Required)

If yes, please describe the triggers and or aggressive behaviors your pet(s) exhibit.(Required)

If yes, please enter the service you would like for us to provide for your pet(s)(Required)

My emergency contact's phone number:(Required)

I understand FULL payment for all procedures done on (or not on) the treatment plan is due on the date or at the time of the pet(s) release. Any estimate of charges or fees for presently planned procedure(s) is only a best approximation and the final invoice may be greater or less than the stated estimate.

I understand all animals admitted must be current on vaccinations and be free of external parasites. Animals not in compliance with the above policy will be treated at owner’s expense.

**I understand that’s animals that are too young to have completed all sets of puppy/kitten vaccines or elderly dogs/cats that have suspending their vaccines due to doctor recommendation are at a higher risk of contracting contagious diseases despite our best efforts to prevent this occurrence.**

I have read the above and acknowledge responsibility for the choices I have selected. I may have a copy of this form upon request. (Signature)(Required)

Today's Date(Required)

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