Pet’s Name *

Boarding Dates *

Is pet taking medications? *

Yes
No

There will be a $4.50 medication charge per medication, per administration for a maximum of $9.00 per day.

Name of medication

Is pet to receive any extra services? *

What does your pet eat? *

Clinic Provided Food
Own Food (Special Diet)
Wet Food
Dry Food

How much & how often?

What date & time will you be picking up? *

Date

Time

Does your pet have any special needs we should know about?

If you are unavailable or in case of emergency, who should we contact?

Name #1 *

Number #1

Name #2 *

Number #2

Do you authorize this person to make emergency decisions if we cannot reach you? *

Yes
No

Do you authorize this person to pick up your pet, if necessary? *

Yes
No

If both you and your representative are unavailable in an emergency, please choose one of the following: *

Do whatever is necessary for the health and well-being of my pet; I accept responsibility for charges.
Render only what you deem critically necessary for the life of my pet; I accept responsibility for charges.

Pick-up hours: Monday - Friday 8 am - 4:45 pm Saturday 8 am - 11:45 am

Pets not picked up by noon on Saturday will incur an additional 2 nights boarding charge.

Pets receiving baths on the day of pickup will be ready after 2 p.m.

I understand that my pet will be treated at my expense for fleas, ticks, or intestinal parasites, if found while boarding.

We are unable to accept any personal items for pets unless the owner is willing to relinquish the item. We are not responsible for any lost personal items (i.e. blankets, toys, leashes, collars, bowls, etc..) We will do everything possible to keep your pet comfortable.

We are not responsible for any missing or lost items (ie leashes, collars, bedding, or carriers, etc..) Please initial to confirm: *

We are not responsible for any missing or lost items (ie leashes, collars, bedding, or carriers, etc..) Please initial to confirm:

I understand the nature of the boarding services provided by Pontchartrain Animal Hospital and the costs I will incur for the services I have requested. I further confirm all of the information contained above and grant authorizations as indicated above.

Client Signature *

Clear Signature

Alternate Number *

Boarding Check-In Form

Boarding Check-In Form

Questions?

Location

Contact Information

Hours

Locations We Serve

(Louisiana) Lacombe

Covington

Mandeville

Pearl River

Chalmette

Metairie

Kenner

(Mississippi) Picayune

Carriere

Bay St. Louis

Gulfport

Diamondhead

Waveland

Pass Christian