Galax Veterinary Clinic-Boarding Request

THANK YOU for choosing to board your pet with us! Our Boarding Facilities will allow your pet to be as comfortable as possible while you are away. Please feel free to contact us for a tour of our facilities at any time. Please do not assume your boarding arrangements are confirmed until we have contacted you to confirm the requested dates. Do not use this form if you have an urgent boarding request-call our clinic directly. IMPORTANT: Boarding dates and arrangements are not confirmed until you have received notification. A staff member will contact you by phone or email. Call or email us if you have not been contacted within 72 hours after submitting your request.

Name*
First Last
Email*
Phone*
Pet Name*
Has your pet stayed with us before?*
- Yes
- No
Approximate weight of your pet (in pounds)?
Drop off Date*
Date Format: MM slash DD slash YYYY
Drop off Time*

: HH

MM
Pick-up Date*
Date Format: MM slash DD slash YYYY
Pick-up Time

: HH

MM
What brand and type of food does your pet currently eat? (i.e. Purina Dry Puppy Food, Science diet canned, etc)
How many times per day do you feed your pet?
What amount do you feed your pet each time you feed (i.e. 2 cups, 1 can AM + 1/2 cup dry PM, etc.)?
Does your pet have any food allergies or intolerances you are aware of?
Please fill out any Comments or Special Instructions below: (feeding, housing, exercise, etc).
Will your pet need any veterinary services? We do require that all pets boarding with us are up to date on vaccinations. Please call our office if you have questions about your pet's vaccine status. Boarding is a great time to do dental cleanings, minor surgery such as mass removal or senior screening.
If your pet will require medication, please provide details. Give the medication name, dosage and times of day to give medication. (There may an extra charge for administering medication-contact us if you need to know ahead of time.)
Does your pet get anxious when you leave him/her?
Is there anything we should be aware of that could endanger your pet while in our care? (i.e. chews up blankets, can slip out of leashes, will fight with other dogs, etc.)
IMPORTANT: If your pet becomes seriously ill while in our care we will attempt to reach you or an emergency contact. IF WE CANNOT REACH YOU IN A TIMELY MANNER what is your preference for your pet's care?*
- Do whatever is needed for my pet. I understand I am responsible for the charges.
- Provide only the care deemed by the veterinarian as lifesaving/critical care for my pet. This would mean NOT treating certain conditions such as scratching excessively or diarrhea due to a food change. I understand I am responsible for the costs of critical care.
- Do not provide any treatment without my or my emergency contact giving authorization. I understand this could result in the worsening of a condition or even death of my pet if I cannot be reached.
Emergency Contact #1*
First Last
Phone*
Emergency Contact #2
First Last
Name
First Last
Emergency Contact #3
First Last
Phone
Subcribe to our Newsletter?
- Yes!