Pre-Boarding Express Registration Form - Valley Veterinary Hospital | Serving the Amherst, Hadley, Northampton area

Valley Veterinary Hospital and Inn for Pets

NEW GUEST

PRE-BOARDING EXPRESS REGISTRATION FORM

This form is to be used for confirmed reservations of NEW guests only. Please call 584-5252 if you do not already have a boarding reservation.

Please fill out and submit this express registration form to our office AT LEAST 48 HOURS PRIOR TO YOUR ARRIVAL to allow us to provide the best care for your pet and to expedite your check-in process.

Owner's Name:

First Last

Pet Name # 1:		Pet Name # 2:
Pet Name # 3:		Pet Name # 4:

Reserved Check in Date:

Reserved Check out Date:

Approx. Time:

Preferred Service Plan:

VIP

Basic

(see web site for descriptions)

Additional Playtimes? ($4 /session) Yes No

Feeding Frequency:

Once Daily	AM	PM
Twice Daily
Other

Kennel Diet (Canine Eukanuba Low Residue/Feline Iams Original dry and canned)

My Pet Prefers:

Dry Food

Canned Food

Both/Either!!

I will supply food (Clearly labeled and sufficient quantity for stay)

My brand of food is:

Amount of food at each feeding in dry cups or cans:

Emergency Contact 1		Phone Number
Emergency Contact 2		Phone Number

Additional Services: I would like the following services performed during my pet�s stay at the INN (additional fees):

Dogs Only: I would like my pet to have a pre-departure bath (no charge for VIP stays of 5 days or more)

Nail Trim

Ear cleaning

Medication administration - Please provide clearly identified and labeled medications with the size of the pill, total dose, and frequency of administration. There is a medication fee of $3 per pet per day.

Medication # 1:
Medication # 2:
Medication # 3:

Personal items that will be left with pets (limit 2 toys per pet, no bedding, no rawhides):

Veterinary Services Needed?

Yes (please describe)

Special instructions regarding this stay:

If your pet is NOT a regular patient of Valley Veterinary Hospital please provide the following:

Name and location of regular veterinarian:

Any chronic medical problems that we should be aware of?

My pet�s behavioral profile:

It is very important that we understand your pet and their individual personality traits so that we can provide the most enjoyable and safest boarding experience for them. Please select from the following behavioral profiles:

1. friendly under any circumstances, has never been aggressive toward any other pet or person
2. very friendly, occasionally nervous or aggressive with other dogs
3. usually very friendly, occasionally nervous or aggressive around new people
4. usually very friendly, somewhat nervous around other pets and new people, has never snapped at anyone
5. fairly nervous or aggressive with new pets or people, has been known to snap but has never bitten any other pet or person
6. very nervous or aggressive with other dogs, has snapped at or bitten other dogs, but never any person
7. very nervous or aggressive around new people, has snapped at or on occasion bitten a person

Please explain anything that you think would help us better understand and safely handle your pet, or make their stay more enjoyable i.e. likes, dislikes, commands, etc:

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