Elmbrook Boarding Check In Sheet

Owner and Pet Information

Pet's Name

Owner's Name

Phone

Emergency Contact Name

Phone

Check In Date

Check Out Date

Feeding Information

What type of food?

How Many Cups of Food Per Meal?

How Many Meals Per Day?

Medication Information

Medication #1 Name

Medication #1 How Much Medication Per Dose?

Medication #1 How Many Doses Per Day?

Medication #1 Should it be given with Food?

Yes

Medication #2 Name

Medication #2 How Much Medication Per Dose?

Medication #2 How Many Doses Per Day?

Medication #2 Should it be given with Food?

Yes

Medication #3 Name

Medication #3 How Much Medication Per Dose?

Medication #3 How Many Doses Per Day?

Medication #3 Should it be given with Food?

Yes

Medication #4 Name

Medication #4 How Much Medication Per Dose?

Medication #4 How Many Doses Per Day?

Medication #4 Should it be given with Food?

Yes

Medication #5 Name

Medication #5 How Much Medication Per Dose?

Medication #5 How Many Doses Per Day?

Medication #5 Should it be given with Food?

Yes

Personal Items

Please list any personal items your pet will be bringing with them:

Special Instructions/Procedures

Please list any procedures you need performed or any special instructions for your pet's stay:

Elmbrook Veterinary Clinic will provide all pets with necessary items during their stay such as blankets, beds, and bowls. We encourage owners to send along their pet’s current diet, and any toys they’d like the pet to have but ask that they leave any beds or blankets at home. Elmbrook Veterinary Clinic is not responsible for the loss or damage of any personal items sent along with your pet.

All pets left for boarding must be current on annual exam and all required vaccinations and free of fleas and ticks, or they will be treated upon admission at the owner’s expense. If medications are necessary for treatment or handling, I give my permission to Elmbrook Veterinary Clinic to administer such medications.

I have been given and read/understand the boarding policy of the Elmbrook Veterinary Clinic. I have a current boarding waiver on file with Elmbrook Veterinary Clinic Boarding.

Sign/Type Your Name Below:

Date