Boarding Release Form

Timberland Animal Clinic

Tender loving care is always provided

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18110 SE Division

Portland,  97236

503.665.1194

BOARDING RELEASE FORM

Name_____________________________Home#____________________

Address_________________________________________zip_____________

Boarding dates from____________________to_________________

 

Pet Names______________________________________

Special instructions for each pet

____________________________________________________________________________________

____________________________________________________________________________________

diet_____________________________________________________________

Medications:______________________________________________________________

Toys/blankets_____________________________________________________________

Please give my pet _________________a bath while boarding. (ask us the charge)

Our boarding Policy :To prevent the spread of infectious diseases and parasites, hospitalized

and boarded animals MUST be current on all vaccines and free of internal and external parasites. Documentation of vaccines is needed.

If not current or unable to provide proof of vaccinations, I give my permission to update my pet(s) vaccinations in accordance with the

above policy. In addition we will examine your pet for fleas. If fleas are present we will treat to prevent infestation of our premises.

I authorize the staff parasite control as needed for my pet. I understand that I will be responsible for the cost thereof.

Signed: ______________________________ Date: __________________

Medical Illness Policy

One of the advantages of boarding your pet(s) at a veterinary clinic  is that veterinary attention is readily available should

the need arise.  If your pet(s) become ill, we will call the emergency number(s) listed below regarding your pet(s) symptoms, treatment

options and estimate of additional costs .  If no one can be reached, however, please indicate your wishes below:

a.________Please perform whatever services the doctor deems necessary for the best care of my pet until someone can be reached.

b._________I authorize up to $100_____$200_____  $______ in medical care

until someone can be reached

c._______Do not administer any medical treatment until specific authorization is given.

please contact:   __________________________Phone# : _________________________cell#__________________________

signature_______________________________ Date:___________