Dog Boarding Reservation Request

Please fill out this form as completely as possible.
Name:
E-Mail:
Daytime Phone Number: XXX-XXX-XXXX
Evening Phone Number: XXX-XXX-XXXX
Date dropping off your pet(s):
Date picking up your pet(s):
Emergency contact while you are gone:
Emergency contact's phone number: XXX-XXX-XXXX
Pet's name:
If more than one dog, would you like: I am boarding one dog-N/A
A separate room
Together in one room
Would you like a: Standard room (63 sq. ft.)
Suite (126 sq. ft.)
Would you like to add a bath to your dog's stay? Yes
No
Would you like to add daily playtimes to your dog's stay? Yes
No
Will you be bringing your dog's own food? (Recommended if you do not feed your dog Hill's Science Diet) Yes
No
What are the feeding instructions for your dog?
Is your dog on any medications? If so, please list medications and instructions for each medication.
Does your dog have any medical conditions? If so, please explain.
Has your dog had a recent illness or surgery? If so, please explain.
Has your dog been boarded at Woodland Hospital for Animals in the past? Yes
No
If you answered "No" to the above question, please fill out the following information.
Address:
City/State/ZIP: ,
Your dog's veterinary clinic:
Veterinary clinic phone number: XXX-XXX-XXXX
How did you hear about us?
Reminder:
We require all pets who are boarding with us to have proof that they are current on their vaccinations.

For dogs:
  - Distemper (DHPP)
  - Rabies (3 year)
  - Bordatella (Cough Guard) (Annual)
  - Fecal Exam (6 months)