the and you

Date of Check In: *

Date of Check Out *

Client Name *

First

Last

Client ID

Patient Name *

Email *

Phone number while patient is boarding *

Alternate phone number or local emergency contact

Westside Veterinary Service

Does this patient need to see a Veterinarian while boarding?

Yes
No

If Yes, Please Explain

History

Is patient eating and drinking okay?

Yes
No

Any coughing, sneezing, vomiting, or diarrhea? If so when did it start?

Yes
No

If your pet is in need of unexpected medical care while boarding with us, would you want the doctor to examine your pet? (Such as diarrhea, coughing, vomiting, not eating/drinking, skin/ear infection, etc.)

Yes, please treat patient then call. (exam fee, plus necessary medications)
No, please call and get permission to treat first.

Medications

Is your pet currently taking any daily medications?

Yes
No

(If yes, remember to get name, dose, how often and when it was last received.)

If yes, list the name of the medication, dose, how often it’s given, and when it was last received:

Disclosure: Any controlled substances will have to be given from our stock while pet is here with us!

Diet

What does your pet eat?

How often?

How much?

Did you bring the pet’s food along for boarding?

Yes
No

Additional Feeding Instructions/Notes

Additional Items Brought

Requirements For Boarding

Boarding animals must be current on all vaccines (Rabies, DA2PP, Bordetella)
Vaccinations can be given at time of drop off for if needed.

Disclaimer

Westside Veterinary Service is not responsible for personal pet items. Due to the high volume of boarders, drop offs and other pets being seen at our clinic, items can easily get moved around and lost.
We provide Hill’s Canine/Feline Maintenance food. If your pet requires other food which we sell, we are happy to invoice and provide that food to your pet if you did not bring it along.
Owners must bring in any medications that the pet is currently taking. If medications are not brought in with pet, cost of medication will be added to the invoice. Controlled Medication cannot be brought back into the clinic. We will charge you for the medication used while your pet is here boarding with us.
In the case of an emergency, a staff veterinarian will treat your pet as necessary. Westside Veterinary Service will attempt to reach you and/or your emergency contact person by phone, but we cannot guarantee such contact. Your signature below confirms that you agree to accept full financial responsibility for all charges related to the treatment of your pet including CPR if necessary while in our care.

Discharge

** Pets may only be picked up during normal hours of operation. **
Between 7:30 AM – 6:00 PM on Monday-Friday and between 7:30 AM - 1:00 PM on Saturday. Pets are not discharged on Sundays or Holidays.

I have read the boarding requirements, disclaimer and discharge.

I approve of the hospital’s policies.

Owner Signature *

Clear Signature

Date *

Easy Payment Solutions ✅ Always Accepting New Patients ✅

Online Forms

Boarding Consent Form