Pet's Name	Check-in Date	Check-out Date/Time
Emergency Contact/Phone Number

We recommend having your pet bathed or groomed prior to pick-up to ensure he/she
goes home clean and free of fleas and ticks.

Bath

Grooming

All groomings include: bath, ear pluck, ear cleaning, nail trim, and anal glands expressed

***Some pets are very difficult to groom. This makes it extremely hard for our groomer to give your pet a quality grooming.
If this occurs, may we have your permission to sedate your pet?

yes

no

Please give comments/instructions on how you would like your pet to be groomed:


To prevent the spread of infectious diseases and parasites, it is the policy of White Oak Animal Hospital
that all boarded and hospitalized animals must be current on all vaccines and free of intestinal and external parasites.

Vaccines Required:	Canine: Bordetella Rabies
	Feline: Rabies

Vaccines Recommended:	Canine: Distemper/Parvo
	Feline: Distemper

Additional services to be performed:


Boarder Playtime DOGS ONLY:
Yes     No     How Often?

Boarding Information:

Medications and dosages to be administered:

Special diet/amount fed/how often:

Personal items left with your pet: (White Oak Animal Hospital is not responsible for lost or damaged items)

May we give your pets treats during his/her stay? Yes     No

I do I do not give permission for White Oak Animal Hospital to perform any necessary treatments should any abnormalities (i.e. diarrhea, ear infection, skin infection) arise for the duration of my pet/pets stay. I also understand that I will be held financially responsible for the cost of such treatment.

I do I do not give permission for White Oak Animal Hospital to treat my pet in the event a life-threatening emergency arises during the duration of my pet/pets stay. I also understand that every reasonable attempt will be made to contact me regarding my pet/pets treatment. In the event that I can not be contacted, I will be financially responsible for the cost of my pet/pets treatment.