PET OWNER INFORMATION
Date Format: MM slash DD slash YYYY
EMERGENCY CONTACT INFORMATION
REGULAR VETERINARY HOSPITAL
AUTHORIZED LIST (Pick-up & Visitors)
PET MEDICAL HISTORY
Has the pet been diagnosed with any medical conditions such as… IF YES, PLEASE EXPLAIN
ADDITIONAL INFORMATION (OPTIONAL)
*PETS MUST BE CURRENT ON ALL VACCINES PRIOR TO BOARDING AND DOCMENTATION WILL BE REQUESTED AT OR
BEFORE TIME OF CHECK-IN
*CANINES MUST BE CURRENT ON RABIES, DHP, INFLUENZA (H3N2/H3N8), AND BORDETELLA. BORDETELLA IS
REQUIRED EVERY 6 MONTHS FOR BOARDING. THE CANINE INFLUENZA (H3N2/H3N8) VACCINE MUST BE GIVEN 2
WEEKS PRIOR TO YOUR PETS BOARDING STAY. IF YOUR PETS VACCINATIONS ARE NOT CURRENT, AN EXAMINATION
BY ONE OF OUR VETERINARIANS IS REQUIRED EVERY 6 MONTHS, PRIOR TO VACCINATING.
*FELINES MUST BE CURRENT ON RABIES, FVRCP, AND FELV. IF YOUR PETS VACCINATIONS ARE NOT CURRENT, AN
EXAMINATION BY ONE OF OUR VETERINARIANS IS REQUIRED EVERY 6 MONTHS, PRIOR TO VACCINATING.
*FOR BEST PROTECTION, VACCINATIONS SHOULD BE GIVEN AT LEAST 2 WEEKS PRIOR TO BOARDING. LIKE THE
HUMAN FLU, NO VACCINE IS 100% EFFECTIVE. WHILE WE DO OUR VERY BEST TO PREVENT ALL INFECTIOUS DISEASE,
YOUR PET MAY COME INTO CONTACT AND/OR BE EXPOSED TO A RESPIRATORY DISEASE.
*ALL PETS MUST BE ON A CURRENT FLEA PREVENTATIVE. IF YOUR PET HAS FLEAS OUR HOSPITAL WILL ADMINISTER A
FLEA PREVENTATIVE AT AN ADDITIONAL FEE, PAYABLE AT PICK UP TIME.
*BRINGING YOUR PETS DIET IS ALWAYS RECOMMENDED TO AVOID DIETARY RELATED ISSUES, HOWEVER WE DO
OFFER A DRY KIBBLE. IF YOUR PET REQUIRES THAT WE CHANGE HIS/HER DIET, THERE WILL BE AN ADDITIONAL FEE. IF
YOUR PET HAS DIARRHEA WHILE BOARDING WE WILL SWITCH YOUR PETS DIET TO “HILLS I/D DIGESTIVE CARE DRY OR
WET” AND ADMINISTER “FAST BALANCE GI PASTE” OR “FORTIFLORA” TO HELP SYMPTOMS OF DIARRHEA FOR AN
ADDITIONAL FEE, PAYABLE AT PICK UP TIME.
*BOARDING SERVICES ARE PAID IN FULL AT TIME OF CHECK-IN.
I hereby consent and authorize you to prescribe, treat, and/or operate on ________________________. You are to use all reasonable precaution against illness, injury, escape, or death of my pet. Town & Country
Veterinary Hospital & Pleasanton Pet Hotel and its staff will not be held liable for any problems that may develop while my pet is in your care. I understand that any medical problems that may develop will be treated as deemed necessary by the staff veterinarian, emergency clinician, or emergency hospital as deemed necessary. I will assume full financial responsibility for any treatment received at Town & Country Veterinary Hospital & Pleasanton Pet Hotel or the emergency hospital if the pet is transferred. Should my pet become ill for any reason following discharge, neither Pleasanton Pet Hotel, Town & Country Veterinary Hospital, or staff will be held liable. If I request treatment for such problems following discharge, I understand I will be financially responsible for any treatment I receive at Town & Country Veterinary Hospital & Pleasanton Pet Hotel, or at a hospital of my choice. If I neglect to pick up my pet within five (5) days of the discharge date and do not notify you within the same time frame, you may assume that the pet is abandoned and you are herby authorized to dispose of the pet(s) as you deem best and/or necessary.
It is understood that your doing so, does not relieve me of financial responsibility for boarding and/or hospital care.
I have read the forgoing and agree.
Pet photography Release Form
I hereby authorize Town & Country Veterinary Hospital and Pleasanton Pet Hotel, to publish photographs taken of my pet during boarding and/or any procedure, for the use in Town & Country Veterinary Hospital and Pleasanton Pet Hotel’s print, online, and video-based materials, as well as other Town & Country Veterinary Hospital and Pleasanton Pet Hotel publications. I hereby release and hold harmless Town & Country Veterinary Hospital and Pleasanton Pet Hotel from any reasonable expectations of privacy or confidentiality
associated with the images obtained during the procedures. I further acknowledge that my participation is voluntary, and I will not receive financial compensation of any type associated with the take or publication of these photographs or participation in Town & Country
Veterinary Hospital and Pleasanton Pet Hotel marketing, educational, informational materials or other publications.
I acknowledge and agree that publication of said photos confers no rights of ownership or
royalties whatsoever. I hereby release Town & Country Veterinary Hospital and Pleasanton Pet Hotel, its contractors, its employees, and any third parties involved in the creation or publication of marketing, educational, and informational materials, from liability for any claims by me or any third party in connection with my participation.