Name *

First

Last

Email *

Best Phone Number To Reach You At *

Pet's Name *

Breed *

Age *

Date In *

Date Out *

Expedited boarders at West Russell Animal Hospital are required to have the following complete before dropping off:
- Canine: Distemper/Parvo, Bordetella, Influenza, Rabies, Fecal (within the last 6 mouths)
- Feline: FVRCP, Rabies, Fecal (within the last 6 months), FELV (Indoor/Outdoor only)

Please select any additional services you would like during your pet's stay:

Nail Trim - $14
Anal Gland Expression - $14
Bath (after 3 nights a courtesy bath is given) - Please call for price
Medical Treatment with Boarding - $3-5/day/pet
Camera Access (Platinum Suites Only) - $18/day

Please list all medications. Include the name, dose, how it's given, frequency, and last time given.

Please describe your pet's diet. Include the name of the food/treats, amount fed, and frequency. *

Estimated itme of pick-up? *

WEST RUSSELL ANIMAL HOSPITAL DOES NOT ACCEPT PERSONAL BELONGINGS. IF YOU MUST LEAVE ANY PERSONAL BELONGINGS, WE ARE NOT RESPONSIBLE FOR ITEMS NOT RETURNED. A WAIVER MUST BE SIGNED TO LEAVE PERSONAL ITEMS. *

I have read and understand.

All necessary precautions are taken to prevent injury and escape of your pet. West Russell Animal Hospital will not be held liable for problems that develop provided that reasonable care and precautions are followed. In the event of a medical emergency, we will contact all phone numbers provided to seek approval for veterinary treatment. *

I have read and understand.

I understand that in the event that my pet has a positive fecal, at owners' expense West Russell Animal Hospital will treat and dispense medication. *

I have read and understand.

Signature *

Please type your name.

Date *