For a limited time, we are offering a NEW CLIENT SPECIAL – $25 Off Your Pet’s First Exam! Learn more here.

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Home Boarding Check In Form

Boarding Check In Form

Client Information

Client Name(Required)

Phone Number(Required)

Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Pet Information

Pet Name(Required)

Breed(Required)

Species(Required)

Sex(Required)

Male

Female

Check-In Date(Required)

MM slash DD slash YYYY

Check-Out Date(Required)

MM slash DD slash YYYY

Any signs of illness in the last 7 days?(Required)

Yes

How was your pet sick and has it been seen for something like that?(Required)

Brand of flea prevention and date of last dose?(Required)

Brand of heartworm prevention and date of last dose?(Required)

Clinic or Client Food?(Required)

Clinic

Client

Brand/Type(Required)

Feeding Instructions(Required)

Any Extras (Spa TNT etc)?(Required)

Any Authorized People to Visit/Pickup?(Required)

Yes

Please List Names of Authorized People(Required)

Is your pet taking medication?(Required)

Yes

How many medications is your pet on?(Required)

1) Name of Medication, dosage and Instructions(Required)

All medication must be in the original packaging with the correct name, dosage, and instructions from prescribing pharmacy/clinic.

2) Name of Medication, dosage and Instructions(Required)

All medication must be in the original packaging with the correct name, dosage, and instructions from prescribing pharmacy/clinic.

3) Name of Medication, dosage and Instructions(Required)

All medication must be in the original packaging with the correct name, dosage, and instructions from prescribing pharmacy/clinic.

In the event of illness or injury, please initial ONE option:(Required)

Call me, if I cannot be reached, proceed with medically necessary services. I understand that this will increase the costs incurred during my pet’s stay.

Call me, if I cannot be reached, proceed with medically necessary services. I understand that this will increase the costs incurred during my pet’s stay. I limit this authorization of additional care without discussing care directly.

Call me, if I cannot be reached, DO NOT perform any additional services without express verbal permission. I understand that in the event that I am unreachable, emergency services will be withheld and Ark Animal Hospital will not perform any examinations, diagnositcs or treatment and will not be held liable in any way if the pet does not receive the medical attention it needs.

Initials(Required)

Authorization of additional care amount.(Required)

Please enter a dollar amount. Ex: $400

In the unlikely event of cardiopulmonary arrest or other life threatening issues, do you want us to provide emergency treatment?(Required)

Yes

By signing this form, I acknowledge that I have read and understand all the above, and that I
have provided accurate information, and agree
to the above terms.

Signature of Owner(Required)