What the Form Covers

Your contact information and an emergency contact while you are away
Your pet’s diet, feeding schedule, and any medications, including dosing
Vaccination status — all boarding pets must be up to date on vaccinations and free of parasites
Special needs, behavior notes, and how your pet does around other animals
Authorization for veterinary care if your pet needs medical attention during their stay

Two dogs resting their paws on a counter indoors

Complete the Form

Fill out the form online below, or download a printable copy to complete at home.

Download a Printable Copy

Name *

First

Last

Email *

Phone *

Pet’s Name *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Color/Markings *

Pet Vaccine History

For the protection of your pet/pets the following vaccinations are required. Please enter the date each vaccine was last given. If a vaccine is past due, enter ‘Past Due.’

Dogs must have Rabies, DHLPP and Bordetella Cats must be up to date on Rabies and FVRCPC

Cats

FVRCPC

Feline Leukemia

Rabies

Others:

Date

Dogs

DHLPP

Bordetella

Rabies

Others:

Date

Is your pet on heartworm prevention? *

Any vomiting, coughing, sneezing or diarrhea? *

Is your pet allergic to any drugs? If so, what drugs? *

Has your pet had any illness or injury in the past 30 days? *

Is your pet on any medications? If so, what? *

If a critical/life threatening problem develops and we can't reach you, may we treat your pet(s)? *

All animals will be given CapStar at the cost of $20 (Does not prevent fleas but kills any fleas that are currently on the animal)

Current Diet:

Special Feeding Instructions:

Personal Belongings (kennel, bedding, food):

Medication Administration

There is an additional $9.75 charge for daily medication administration.

If you are boarding and forget your animal’s prescription, a new prescription will be made at owner’s expense.

I agree

Pick Up Date

Date

Time

Please list any veterinary concerns or other needs to be addressed?

NOTICE: Personnel are not on the premises at night and other times when Liberty Hill Veterinary Wellness is not open for business. *

I have read and understand.

Owner Release

I understand you cannot guarantee the health of my animal. I understand and will not hold the clinic responsible for conditions that are unavoidable in boarding kennels, such as but not limited to weight loss, hair loss, upper respiratory infections, bronchitis, diarrhea, and fleas. I understand all pets admitted to the clinic must be protected against communicable contagious diseases and must be free of internal and external parasites or will be treated on entry or discovery at the owner’s expense.
If vaccinations were performed elsewhere, I can provide written documentation of the Rabies vaccination administered by a licensed veterinarian within 24 hours of notification to do so in the event my animal should bite any person or other pet while on the clinic premise
I understand that in the event of my animal’s illness, the staff will immediately attempt to contact me or my agent to discuss the problem and treatment options, but may not be able to contact me immediately and is therefore authorized to initiate appropriate treatment until myself or my agent can be reached. Should an EMERGENCY arise, I authorize the medical staff to sedate my animal and or perform such emergency procedures as may be necessary for the health of my animal until I can be notified. I agree to pay, in full, all charges for necessary services rendered for and to my animal.
I understand that the clinic is not responsible for loss or damage to personal items left with the pet including but not limited to leashes, collars, toys and bedding
The clinic is to use all reasonable precautions against injury, escape or death of my animal. The clinic and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed. I understand that any problem that develops with my animal will be treated as noted above and I assume full responsibility for the treatment expense incurred

Owner/Agent: *

Emergency Phone Number *

Date / Time

Signature

Clear Signature

Comment

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Boarding Release Form.

What the Form Covers

Complete the Form

Pet Vaccine History

Cats

Dogs

All animals will be given CapStar at the cost of $20 (Does not prevent fleas but kills any fleas that are currently on the animal)

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Location

Contact Information

Hours