Name Last Pet's Name Species Breed Sex Spayed/Neutered Color DOB I am placing my pet in the care of the Prima Vista Animal Hospital, with the understanding that the hospital will use reasonable care to keep my pet in good health. I will not hold the Prima Vista Animal Hospital liable and I assume all risks for the boarding, bathing or grooming of my pet. In case of illness I do hereby give my consent for Prima Vista Animal Hospital a to stabilize the condition by treatment, prescribing for or operating upon my pet(s) as deemed necessary by the attending veterinarian until such time the owner can be contacted. Any expenses incurred shall be paid promptly by the owner.Should the circumstances arise that my pet(s) remain unclaimed after the date, which I have stated as the pick-up date, I understand that an attempt to notify me will be made. Seven days after such notice the pet(s) will be considered abandoned and property of Prima Vista Animal Hospital. It is further understood that such action will not relieve me from paying all costs of services and the use of you hospital.I understand that an intestinal parasite screen (current within 6 months) and all vaccinations for dogs (Distemper, Lepto, Influenza, Hepatitis, Parvo, Rabies, Corona & Bordetella ) and for cats (Leukemia, Distemper Combination, Rabies and Bordetella) must be curr ent within one year (excluding Bordetella for dogs which is to be current within 6 months) for boarding, bathing and grooming. If these vaccinations or intestinal parasite screen are not current, Prima Vista Animal Hospital will administer/perform them.I also acknowledge that I have written down all abnormalities and special requirements that are needed for the care of my pet .Furthermore, I understand that the Prima Vista Animal Hospital strives to be a “Flea Free” boarding facility. Therefore, if my pet is not currently on any flea preventative or fleas are found on my pet upon arrival, Prima Vista Animal Hospital will administer a flea preventative of their choosing to prevent any possible infestation of fleas during my pet’s stay and I agree to pay for the above mentioned product or services.Special Instructions/Medical Conditions:Authorization to Verify Vaccination Records: For the safety of my pet and others I hereby verify that all vaccinations stated above for my pet are current within 1 year. I hereby authorize Prima Vista Animal Hospital to verify these vaccinations at If these vaccinations are not current, I authorize Prima Vista Animal Hospital. to administer them immediately.I would like to follow my pet’s boarding on Facebook.I would like my pet to have a bath or groom before pick up. Receptionist will give price quote.YesNoOwner’s Signature First Last Date MM slash DD slash YYYY Emergency Contact NumberThis agreement, when signed, is good for one-year from the original signature date.De-matting Fee(for Grooming Only): I also understand that if my pet is heavily matted, I will be charged a dematting fee based on $20 per hour, in addition to the quoted grooming price as per my conversation with the groomer.Services Available (Additional Fees Apply)Date of Entrance MM slash DD slash YYYY Date of Pick-up MM slash DD slash YYYY Facebook PictureAccepted file types: jpg, Max. file size: 10 MB.Bath or GroomBathGroomNoneExtra ExerciseYesNoGive Flea PreventionYesNoNail TrimYesNoGive Heartworm PreventativeYesNoTeeth BrushingYesNoInitials
