Todays Date:
Boarding until what date:
Where will this pet be staying:
What kind of food are we feeding:
How much and how often:
Any medications:
Patient Belongings:
Yes No
I understand that there is a separate fee per day, per dog for medications given
while boarding.
Yes No We take all precautions to make sure your pet is free of fleas on entry and dismissal.
Your animal will be given a Capstar tablet on arrival that will kill any fleas within 10 minutes. This
will also protect your pet if another boarder were to come in with fleas. It has no
contraindications with any medications or other flea products. This is an additional charge and
will depend on the weight of your pet.
Yes No We are not responsible for blankets or toys left with your pet. Our pets are rotated
and walked multiple times a day and often toys are misplaced. We apologize ahead of time
and do have towels and blankets we offer from our supply.
Yes No Reasonable precaution will be used against injury, escape or death of this pet. The
clinic is equipped with fire and burglar alarms. The clinic and staff will not be held liable for
problems that develop provided proper care and precautions were followed. I understand that
the clinic is not staffed 24 hours a day.
Yes No I give Muddy Branch Veterinary Center permission to treat my boarder as they see fit
in case of an emergency or sickness. I agree to pay up to __ if medical treatment is needed
and I cannot be reached while my pet is boarding at your facility. If the annual exam is overdue
there will be an additional $52 to get the exam up to date.
Yes No We provide a go home bath and brush-out, along with a clip from our certified
groomer. Would you like a go home bath.
Any special grooming requests (ex. oatmeal shampoo, shaved, ect..)
Phone number:
Emergency contact and phone number:
Client Signature:
Date