SPAH Cat Boarding Form

Welcome to the "Meow-iott" at South Putnam Animal Hospital

Owner's Name *This question is required.

Cat's Name *This question is required.

Admission Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Pick-Up Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Please Select One: *This question is required.

Number(s) where you will be reachable during your cat's stay *This question is required.

Name and number of party able to give authorization for medical treatment in case of emergency and you are unreachable *This question is required.

Vaccines Required *This question is required.

Date of last physical exam

Date of last Rabies vaccine

Date of last Distemper vaccine

Where were vaccines give (name + phone #):

Flea Treatment:
To provide the best possible care for all of our boarders, each pet admitted to the hospital will be examined for fleas and flea dirt. Each pet exhibiting evidence of fleas will need to be treated while here.

Is your pet currently on medications?

Please fill information below:

Name of Medication/MG:
Dose given:
When last dose was given prior to boarding:

Diet to be fed*:
Please note if your pet is on a prescription diet for health reasons, we may ask you to provide food if it is not a diet we have in stock.

Brand of Food:
Amount Fed:
How Often:

Special Behaviors:
Please note if your pets has any habits/needs your cat has that we should be aware of to best care for him/her.

*Please be aware that we may need to adjust your cat's medication and/or diet based on his/her needs while boarding with us.

Hospital Policies: *This question is required.

It is the policy of our Hospital to require a minimum deposit of 50% of the boarding fee for your cat’s stay. Please leave this payment with the receptionist when signing your pet into the hospital. Amount of Deposit $:

I understand that if a medical problem is discovered, South Putnam Animal Hospital will telephone me or my emergency contact to discuss the problem and determine the course of necessary steps to diagnose and treat in accordance with current medical standards. In an emergency situation, measures to preserve and stabilize vital function shall be taken immediately without first contacting me or my emergency contact. Initial:

Occasionally, pets will vomit or not eat well, or have diarrhea while boarding with us. This may be due to the stress of being away from home. When this happens, we offer several different types of food to try to entice them to eat. Sometimes we need to give pets an appetite stimulant, medication for nausea or diarrhea, or fluids under the skin to help them feel better. In the event that my pet becomes sick while boarding, I give permission to have him/her treated at the discretion of the veterinarian, up to a cost $100. Initial:

You are to use all reasonable precaution against injury, escape, or death of my pet. The hospital and staff will not be held liable for any problems that develop provided reasonable care and precautions are followed.. By signing this contract, I am stating that I am the owner of the above pet or their authorized agent and guarantee that I have the authority to sign this contract and am personally liable for expenses for lodging, veterinary services, and any other fees incurred while my pet is boarded. I UNDERSTAND THAT ALL CHARGES ARE DUE AND PAYABLE UPON DISCHARGE OF MY PET. I ACKNOWLEDGE THAT I AM OVER 18 YEARS OF AGE.

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Signature of

Authorization for person other than owner/agent listed to pick up pet

Signature of Authorized Person

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