Lodging Information Form - Country Friends Veterinary Clinic

Today's Date *

Owner's Name *

First

Last

Email *

Phone *

Patient's Name

Check-In Date *

Check-Out Date *

Is your pet currently on any medications aside from prevention? *

Yes
No

If yes, what medications are they on and how often are they administered? *

Will your pet be bringing their own food? *

Yes
No

How much and how often do you feed your pet? *

If my pet is not eating, I give Country Friends Veterinary Clinic permission to provide my pet with canned food (EN, OM, or Recovery)without contacting me first *

I accept

I realize that any CFVC canned pet food cost will be added to my boarding charges. *

I accept

Country Friends provides your pet with blankets and bowls during their stay. Will you be bringing any of your pet's belongings for their stay? *

Yes
No

Please list the items you plan on bringing below. Please note that some toys and treats may be considered unsafe to have during unsupervised time periods. *

Is your pet getting a bath during his/her stay?

Yes
No

If my pet needs medical attention during his/her stay, the staff at Country Friends Veterinary Clinic - 1. HAS 2. DOES NOT HAVE - my permission to provide treatment and/or can food at an additional cost to me.

Has
Does Not Have

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. Any estimate of charges or fees for presently planned procedure(s) is only a best approximation and the final bill may be greater or less than this amount. *

I have read the above conditions for treatment and acknowledge that I may have a copy of this form, if requested.

All fees for services are due when patient is released.

I have read and understand.

Please list Emergency Contact Numbers:

Owner/Agent’s Signature: *