Name *

First

Last

Date *

Email *

Phone *

Emergency Contact *

First

Last

Emergency Contact Phone *

Pet's Name *

Vaccinated

Yes
No

When/Where

Please list any medications that your pets need while boarding, along with instructions.

Feed clinic food (Science Diet Sensitive Skin and Stomach)? *

Yes
No (must bring pets food)

If NO, Pets Food:

Is your pet a picky eater?

Yes
No

Please list feeding instructions. *

When is your pet due for their next meal? *

Is your pet known to shred blankets/newspaper?

Yes
No

If yes, are you comfortable with your pet not being provided a blanket?

Yes
No

If no, you understand Corbin Animal Clinic LLC is not responsible for foreign bodies from consumption of shredded material.

Does your pet get stressed and not eat at times?

Yes
No

If yes, does your pet need medication for anxiety?

Yes
No

Additional Services: (please check all that you want done)

Other additional services

My pet flea/tick prevention is

Last given on

Does she/he have any aggression towards people, other animals, or in cage? *

Yes
No

In order for safety please describe

Does your pet have any personal items? If so, please list and describe items

If a critical/life threatening problem develops and we can't reach you, may we treat your pet(s)? *

Yes
No

I authorize Corbin Animal Clinic to take photos of my pet(s) and use for any lawful purpose, including, publicity purposes, illustration, advertising, and web/social media content. *

Yes
No

Is there anyone in the household that has a peanut allergy that would require us to not potentially use peanut butter during an exam to make a pet focused? *

Yes
No

I and *

are authorized to pick my pet up from boarding. I understand if I or the person listed above is not picking up the pet Corbin Animal Clinic will not release my pet to them.

I understand that Corbin Animal Clinic LLC does NOT perform overnight care, and will provide staffing for weekend care and other instances when the office is closed. I understand that I will that I will be contacted in case of emergency. However, if I cannotbe reached I authorize Corbin Animal Clinic LLC to perform lifesaving treatment on my pet. I also understand that I will be responsible for all financial charges that may occur with this. I do not hold Corbin Animal Clinic LLC responsible for any injuriesor illnesses suffered by my pet. I release Corbin Animal Clinic LLC from any liability due to loss of my pet(s) blankets, toys, bowls, containers, leashes, beds, and anything else I elect to bring with my pet while staying at their facility for boarding.I understand that Corbin Animal Clinic LLC does require that my pet be on flea/tick prevention for the protection of my pet and other boarders. If my pet is not current on veterinary dispensed flea/tick prevention, Corbin Animal Clinic LLC will apply medication at an extra charge.I have given accurate information about my pet(s) to the best of my knowledge. I have also read and understand all above statements.

Fees are charged on a per night basis. Pets are released only during normal business hours. Animals will not be released until services are paid.

Signature *

(must be 18 years or older)

Date *

Corbin Animal Health & Wellness

Boarding Form

Boarding Form

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