Boarder Intake Form

Pet Boarding – Additional Information Form

Patient and Pet Details

*Today's Date:

*Client's Full Name:

*Email Address:

*Phone Number:

*Patient's Name:

*Sex:

*Date of Birth:

*Species:

*Age:

*Breed:

Feeding Instructions

Are you providing your pet’s food?

YesNo

For dogs and cats, if you do not provide your own food, Hill’s Science Diet Sensitive Skin & Stomach will be provided. Pellets are not provided by our boarding facility; however, we do provide Timothy Hay for all rabbits and guinea pigs.

Feeding Schedule:

Once DailyTwice DailyThree Times DailyFree Feed

Amount Per Feeding:

Special Instructions (e.g., mix wet & dry, any food allergies, use slow feeder etc.):

Medications

(If your pet is on medication, there will be an additional administration fee.)

Medication 1:

Medication Name:

Dosage:

Frequency:

Last Given:

Medication 2:

Medication Name:

Dosage:

Frequency:

Last Given:

Medication 3:

Medication Name:

Dosage:

Frequency:

Last Given:

Special Instructions (e.g., give with food, apply topically, refrigeration needed, etc.):

Belongings

Please list in detail any items you are leaving with your pet:

(Note: Pinellas Animal Hospital is not responsible for lost or damaged items.)

Commands & Special Considerations

Commands your pet responds to (e.g., Sit, Stay, Down, Off, Come, etc.):

Does your pet have any behavioral concerns (e.g., anxious, aggressive, escape artist, fear of storms, etc.)?

YesNo

If yes, please explain:

Any medical conditions we should be aware of (e.g., allergies, arthritis, seizures, diabetes, etc.)?

YesNo

If yes, please explain: