Required Fields in Red

    Client Name:

    Pet Name:

    Phone Number:

    Pick Up Date & Time:

    If you pick your pet/pets up after 12PM you will be a charged half a day fee

    Drop Off Date & Time:

    Notes: Anything we may need to know?

    Feeding Instructions:
    Must Provide Own Food (Each meal is to be separated & labeled.)

    Hay Amount:

    Pellets Amount:

    Insects Amount:

    Veggies/Fruit Amount:

    Avian Food Amount:

    How many times a day?

    Does your pet still need to be fed today?

    Does your pet have any special feeding instructions?

    Medications & Supplements: There is a fee of $2.00 per administration.

    All medications MUST be kept in their original container. Do NOT mix with food.

    Medication:

    Dose:

    Medication:

    Dose:

    Medication:

    Dose:

    When do we need to start medications?

    Flea Prevention: LAH is a flea free environment. If your small mammal is found to have fleas they will be treated at the owner’s expense, typically a range of $20-$30.

    Pet’s Personal Belongings: (Lanier Animal Hospital is not responsible for lost or damaged items.)

    Special Care Instructions (Must bring anything needed):

    How Long?

    How often?

    Time on & Time off

    Other:

    Hygiene Services: If you would like your exotic pet to have these services while he/she is boarded, please check the boxes below.

    Veterinary Services:
    Does your pet need to see a veterinarian for any services?

    (Examination fee applies. Please allow time at check in for our technicians to get a history on your pet.)

    Are there any problems or concerns? Please list:

    IN CASE OF AN EMERGENCY OR ILLNESS: The doctors at Lanier Animal Hospital will make every effort to contact you or your emergency contact in the event your pet becomes ill during his/her stay with us. However, in the case we cannot reach you or your emergency contact, we will do an exam & start medication on your pet at your expense, which typically does not exceed $250. We do not want your pet to suffer or to put other pets at risk for potentially contagious diseases.

    Special Instructions for emergency care:

    Preferred contact method:

    Primary Authorized Emergency Contact:

    Name:

    Phone:

    Email:

    Secondary Authorized Emergency Contact:

    Name:

    Phone:

    Email:

    Email (For communication while your pet is boarding, especially if you can not be reached by phone):


    Signature:

    Date: