Boarding Form - Gentle Care Animal Hospital at Tryon Rd.

Owner Name*

First Last

Pet's Name*

DROP OFF/PICK UP INFORMATION:

Drop off date

Pick up date

Pick up time

: HH

MM

Primary Contact

First Last

Phone

Alternate Contact

First Last

Phone

Is there someone other than yourself authorized to pick up?

Yes
No

Name

If your pet is NOT a patient at Gentle Care please list your regular veterinarian and contact number

Hospital Name

Phone

In the very rare case of life-threatening illness, we will always stabilize your pet and contact you immediately.

For purposes of consent for further treatment beyond stabilization (Please choose all that apply):

Please call me at my primary contact number to get consent for further treatment
If you are unable to reach me, I give permission for my alternate contact to give consent for further treatment

If unable to reach either contact (Please choose ONLY one):

I give my consent for the Doctor on duty to fully treat my pet
I do NOT give my consent for any further treatment beyond stabilization until I can be reached

For instances of non-life threatening illness (e.g. diarrhea, ear infection), please indicate your wishes:

Treat without calling contact(s)
Treat and call contact(s)
Call before any treatment

FLEA PREVENTION (required):

Type used:

Date last applied / given:

FEEDING INFORMATION:

Will you bring your own food?

Yes
No

If yes, what brand?

Amount to feed:

AM

Lunch

PM

Are you bringing treats?

Yes
No

If yes, give number of treats

AM
Lunch
PM

CURRENT MEDICAL CONDITIONS:

Does your pet have any current medical condition(s)?

Yes
No

If so, please list:

Current medications, dosing, and frequency: ONLY BRING MEDICATION IN ORIGINAL BOTTLES OR PACKAGING

1.

2.

3.

4.

5.

6.

Do you have any other concerns we should be aware of (e.g. anxiety, fear-based aggression, mobility/arthritis issues)?

PLEASE CHOOSE ANY A LA CARTE SERVICES YOU’D LIKE YOUR PET TO HAVE:

Individual Playtime 15min ($17/day)

Yes
No

# of days:

Group Daycare w/ Hotel ($14/day - dogs only)

Behavior evaluation required to participate.

Yes
No

# of days:

Deluxe Bath ($22-63):
Exit Bath ($22-43):
Nail Trim ($18.58)

(Exit Bath Doesn’t Include Nail Trim or Ear Cleaning. The prices vary based on size and length of hair coat.)

Grooming (by appt. only) Is Your Dog Getting Groomed

Yes
No

Signature