Lexington Boulevard Animal Hospital
Boarding Form
Any animal with fleas will be bathed and dipped upon entering the kennel.
Owner:_______________________ Pet:_______________________Pickup Date:_____________

Any special diet: Canned _______________ Dry _______________
When did you feed last?___________________________________________________________
(Dry Science Diet fed in hospital if no notation is made, unless you provide your own food.)

Any known allergies or sensitivities?  Yes   No  If yes, describe:_____________________

Is your pet on heartworm preventative?  Yes  No
If "yes", date to administer______________________ Type_______________________________
Did you bring them?  Yes No        Do you want us to supply them?  Yes No

I understand that it is very important the heartworm preventative be given
at the correct dosage and on a regular basis or it can be very harmful.

Is your pet on any other medications?  Yes No
Describe type and dosage:
1)_______________________________________ Last time medication given _______________
2)_______________________________________ Last time medication given _______________

Did you bring medications?  Yes No

Do you want us to provide the medications from our pharmacy?  Yes No

Any special instructions or habits (i.e. food aggression, prefers males/females, etc.)
_______________________________________________________________________

Articles brought with animal (toys, towels, etc.)
Please list:_______________________________________________________________
_______________________________________________________________________

For our diabetics:  Insulin type:____________________ Units:_______________________
                             Last dose:_____________________ Last feeding:__________________
I authorize the Veterinarian to treat my animal in case of an emergency. When time allows, Lexington Boulevard Animal Hospital personnel will make every effort to contact the animal's owner. Until such a time, unless otherwise specified below, I hereby consent to and authorize the performance of such procedure(s) as are necessary according to the Veterinarian's professional judgment.

Comments: _____________________________________________________
______________________________________________________________
I agree to pick up my animal at the designated time. Five days from this date, I understand that the animal is considered abandoned unless other arrangements have been made. At such time, I relinquish all claims to my animal and Lexington Boulevard Animal Hospital is at liberty to humanely dispose of the animal as deemed fit. I understand that this does not relieve me of the responsibility of payment of accumulated hospital and boarding charges.

Emergency Numbers:______________________________________________

_____________________ ________________________________
Date Signature of Owner or Agent