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Boarding Form

A confirmed reservation must precede submission of this form. We are not yet booking reservations on-line. You can save time by filling out this form before you visit. Please call 703-713-1200 to make an appointment before visiting. We welcome you and your pet to our hospital.

If you prefer, you may print out this form and bring it with you.

Clocktower Animal Hospital

• Agrees to exercise reasonable care, keep the premises sanitary, use a double lead if the pet is walked outside, feed twice daily or as directed by the owner, and medicate as indicated below.
• Agrees to notify the owner if the pet becomes seriously ill. If unable to contact the owner or reach their local emergency contact person and the pet's health demands immediate medical response, the veterinarians will treat the pet as if it were their own.

The Owner

• Acknowledges awareness that Clocktower Animal Hospital is staffed the following hours and that staffing during other hours is intermittent: Monday-Friday 7AM-8PM, Saturday 8AM-4PM, Sunday 10AM-4PM
• Agrees to pay all expenses for boarding, vaccinating, bathing if needed, and any additional veterinary services required as outlined above.
• Represents that she/he is the legal owner of the pet and the pet has not been exposed to any contagious disease within the last 30 days and the required vaccinations are current.

Owner Information

Full Name:
E-mail Address:
Home Phone:
Work Phone:
Address:

City: State: Zip:

Emergency Contact:

Home Phone:

Entering Date Pick Up Date

Phone number where owner can be reached

Patient Information

Pet's Name:
Birth Date:
Species:
Breed:
Color:

* Sex: Male Female
* Neutered/Spayed?: Yes No

Nutrition:
What food(s) do you feed your pet?

Dry	Brand
Wet	Brand

Amount and Time(s) daily:

Additional nutrition comments:

Medications left with pet (if any):
Please include name of medication, what time(s) of day the medication is given,
and how much of the medication to give for each dose.

Items left with pet:
i.e. carrier, bed/blanket, toys, ect

Admittance Verification

Cat:	Rabies	FVRCP	FELV
Ferret:	Rabies	DHL

To Be Filled Out By CAH

Coat Condition and Flea Check:

Admitting

Departing

Care Estimate

Board	@$	Daily
Medicating	@$	Daily
Elective Medical Care
Procedure		Estimated @$

Admitted by: _______________

________________________________________	________________
Signature of Owner or authorized Agent*	Date*

* If form is sent to Clocktower Animal Hospital these are to be signed on arrival. If form is printed out you may sign before handing the form in upon arrival.

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