Boarding Form

Name: Lakeview Veterinary Hospital
Address: 6245 Memphis Street, New Orleans, LA, 70124, USA

OWNER CONTACT INFORMATION
Name*
First Last
Phone*
CHECK IN
Date
Date Format: MM slash DD slash YYYY
Weight
Pet's Name
- Dog
- Cat
- Exotic
Would you like to receive text updates while your pet is boarding?
- Yes
- No
Cell Phone
Arrival Date
Date Format: MM slash DD slash YYYY
Pick-up Date
Date Format: MM slash DD slash YYYY
Pick-Up Time
: HH
MM
EMERGENCY CONTACT INFORMATION
Name
First Last
Phone
Name
First Last
Phone
Is anyone other than you authorized to pick up this pet from boarding?
- Yes
- No
Name of Person Picking Up Pet
First Last
Cell Phone of Person Picking Up Pet
FEEDING INSTRUCTIONS
All boarding pets are fed Royal Canin Gastrointestinal LF Diet. We are happy to feed other diets at your request. We encourage you to bring your pet’s food during his stay with us. Please write your pet’s name and last name on any containers or bags you may be leaving with us.
Normal diet food
Amount fed per feeding
Times of day fed
Last time fed
Have you brought food for your pet to eat while boarding?
- Yes
- No
Have you brought treats for us to give your pet?
- Yes
- No
How often?
OTHER SERVICES
Please check off any services you would like performed
- Bath (ear cleaning included)
- Medicated Bath
- No Bath
- Nail trim
- No trim
- Check nails
- Anal glands
Owner provided shampoo?
- Yes
- No
Other services requested
MEDICATIONS
Type of heartworm and flea prevention
Date of last prevention given
Date Format: MM slash DD slash YYYY
Please specify what medications your pet is on, the dosage/directions and when it was last given to them
PERSONAL BELONGINGS
We provide every patient with comfy bedding. We strongly encourage you to leave personal bedding, clothing, towels or toys at home. We are concerned that your belongings will become lost or damaged. Please label any items that are being left with your name and your pet’s name. Any items that become soiled will be cleaned in house. We are not responsible for any lost or damaged items.
Please provide a detailed list of any items being left with your pet
Does your pet need to be examined by a veterinarian?
- Yes
- No
Reason for exam/visit
Date of last vaccination
Date Format: MM slash DD slash YYYY
Name of clinic/hospital
City and state
Please check that you have read and understand the following boarding guidelines:
Should a pet become ill during their stay, we will make every reasonable effort to contact the owner and advice them of the situation. Until that time, LVH will be authorized to give necessary care or treatment for the pet at the owner’s expense.*
- I understand the above statment
All pets must be free of internal and external parasites. Any pets found to have fleas, ticks, intestinal parasites or fungal infections will be treated immediately at the owner’s expense.*
- I understand the above statment
All pets must be current on required vaccines. If pets are found to be overdue or if vaccines cannot be verified by phone or fax, they will be given upon admittance for boarding*
- I understand the above statment
Boarding pets can only be picked up from LVH during the following times: Monday through Friday, 7:30am-5:30pm, and Saturday, 8am-2pm*
- I understand the above statment
Boarding pets must be picked up prior to 2:00 pm, otherwise, they will be charged for that day of boarding.*
- I understand the above statment
I give permission for Lakeview Veterinary Hospital to use photos of pets on a website or social media.*
- I give permission
- I do not give permission
Signature
Date
Date Format: MM slash DD slash YYYY