Online Boarding Form - American Animal Hospital

Client Name *

First

Last

Email *

Phone *

Drop Off Date *

Pick Up Date *

Pet's Name *

Pet's Age *

Pet's Weight *

Pet's Sex *

Male
Female

Please select the following boxes if you pet is exhibiting any of these symptoms within the last 7 days:

When was your pet's last meal? *

Additional notes for the doctor:

Preferred number to be reached at: *

Would you like your pet to be bathed?

Yes
No

Will you be providing food or would you like us to provide food? If you are providing, please let us know the brand, type, amount, and frequency of feeding. *

Please list all medications your pet is currently taking. Be sure to bring them in original bottles and let us know if any refills are needed while your pet is staying with us.

Does your pet have any allergies?

When was your pet last given flea/tick treatment? Brand name of treatment?

If your pet is not up to date on required vaccines you must bring them in prior to their reservation to have this done. This ensures the health and safety of not only your pet but our guests staying with us! *

I have read and understand.

Are there any special concerns while staying with us?

Any problems that need to be addressed by the doctor?

Please specify the name of anyone authorized to pick up your pet other than you.

All payments are due at time of service. Please feel free to ask for an estimate or medical treatment plan prior to providing services. We accept Visa, MasterCard, Discover, American Express, CareCredit, Cash, and check. *

I have read and understand.

In case of emergency, I recognize that American Animal Hospital will proceed with the necessary treatments and procedures to care for my pet. *

I have read and understand.

Digital Signature *