Fayetteville Animal Clinic Boarding Registration Form

Fayetteville Animal Clinic Boarding Registration Form

Please provide paperwork, or proof of vaccination, if your pet has been vaccinated elsewhere when you drop them off!
*Pet(s) must be current on vaccinations or they will be given at the owner’s expense.

Boarding Reservation Dates
From

MonthDayYear
Date
To

MonthDayYear
Date
Client Name
Pet(s) Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Contact Number(s):

Area CodePhone Number
Emergency Contact Person
Emergency Phone

Area CodePhone Number
Toys or Personal Belongings:
Special Needs (i.e. diet or medications):
ADDITIONAL OPTIONAL SERVICES

(Sdditional charges will be applied)
Physical Exam by Veterinarian-List details of concern:
Vaccinations

RabiesDHLP ParvoBordetellaFVR CPFeline LeukemiaCanine Heartworm TestExpress Anal GlandsFlea & Tick BathNail TrimFeline Leukemia & FIV TestFecalHomeAgain Microchip Identification
PERMISSION TO TREAT Should my pet(s) become ill, a FAC veterinarian may provide treatment deemed necessary by the doctor’s professional judgment. I acknowledge that in the event of my pet’s illness, the FAC staff may not be able to contact me immediately. I therefore authorize initiation of appropriate treatment until I can be reached. I understand that I assume financial responsibility for all services rendered and agree to pay all charges (including boarding costs) upon release of pet from the clinic.

I have read and fully understand this boarding registration form.
In the event of an emergency situation, I authorize*

YesNo
FAC to do whatever you deem necessary to treat my pet.
Should be Empty:

Fayetteville Animal Clinic Boarding Registration Form

*Pet(s) must be current on vaccinations or they will be given at the owner’s expense.

ADDITIONAL OPTIONAL SERVICES

FAC to do whatever you deem necessary to treat my pet.