If submitting this form within 24 hours of your scheduled appointment, please print page and bring to your appointment.

Reservations For (Pet’s Name):__________________________________

Check-In Date:____________________ Check-Out Date:___________________

Medications to be administered: ________________________________________
___________________________________________________________________

Does your pet need any of the following?

_________Vaccinations ________ Grooming __________ Bath & Dip

_________ Special Food (If so, name of food_______________________________)

Other:_______________________________________________________________

All animals entering the hospital must be current on all vaccinations and free of fleas and ticks. If they have fleas or ticks, or need vaccinations, they will be treated at the owner’s expense.

Fees are charged on a per day basis, meaning that you will be charged for the day you drop off as well as the day you pick up, unless picked up before 9:00 AM.

I authorize the veterinarian to do whatever is necessary should an emergency arise, and to include tranquilization as required. I agree to pick up my pet on the above check-out date. If failure to do so, a $5.00 per day charge will be assessed to the original boarding fees for each day that my pet stays past the above check-out date.

My pet will be considered abandoned if I fail to recover my pet within 10 days past the check-out date and automatically authorize Parkway Animal Hospital to dispose of my pet as deemed professionally necessary.

If you are a new client, payment is due prior to admitting your pet; otherwise it is due upon release.

Signature:______________________________________________

Date: _________________________________________

Emergency Phone Number: _________________________