ISLANDS PET RESORT

1530 W. Elliot Rd.  Gilbert AZ 85233

480-892-1769    Fax: 480-926-1211

Client Information

Name __________________________________________________                          Date ___________

Address _________________________________________________City____________ Zip _________

Home Ph No. _____________________________________

Time of Admission ____________________Date to be Released _______________________________

________________________________                                                 ____________________________________

Emergency Contact #1                                                                             Name and Relationship to You

________________________________                                                 ____________________________________

Emergency Contact #2                                                                             Name and Relationship to You

Pet Information

Name _______________________□ Dog □ Cat                   Name ___________________________□ Dog □ Cat  

Age ___  Breed __________ Gender ___ Color _____         Age ___  Breed __________ Gender_____ Color_____

Please attach vaccination records

If your Pet(s) is not a patient at our hospital, we require documentation from a licensed veterinarian that verifies your pet(s) is current on the required vaccinations and a copy of this record provided to our hospital.

If your Pet(s) is found to have fleas or ticks upon arrival to our hospital, a Vectra (flea and tick treatment) application will be administered at the appropriate fee.

Emergency Care, Behavior and Pet Health

Emergency Care: We will provide life-saving care in the event of an emergency or accident at your expense. Some owner’s with very ill or debilitated pets may elect not to have their pets resuscitated in the event of an acute, life threatening illness or injury. Please select what type of care you would like for your pet – we will make every attempt to contact you as soon as possible:

____The staff at Islands has my permission to provide life-saving emergency care, if it should be required and

I agree to pay for all services.

____I elect NOT to have my pet revived if life-saving emergency care should be needed. Please do NOT

resuscitate my pet with CPR or other means.

Behavior: We reserve the right to refuse to accept a Pet for boarding if it appears to us that your Pet is sick or that its

behavior could jeopardize the health or safety of other Pets or our staff.

To your knowledge, your Pet(s) has not been exposed to Rabies, Distemper, Kennel Cough or any other

contagious illness within 30 days prior to arrival date of boarding with us.

Pet Health: If your Pet becomes sick (such as diarrhea, vomiting, coughing, or any other type of sickness) or injured and requires medical attention, please check if you prefer to be _____contacted prior to treatment, or, _____begin

treatment until you can be reached.

You acknowledge that in the event of your Pet’s illness, the staff at Islands may not be able to contact you immediately and is therefore authorized to initiate appropriate treatment until you or your agent can be reached and you agree to pay all related expenses associated with the treatment of your Pet until you are available to discuss further treatment and fees with one of our veterinarian’s.

If you refuse medical treatment for your Pet, Islands may engage the services of one of our staff veterinarian’s and/or

administer medicine to make your Pet as comfortable as possible until picked up by you or the named guardian/agent and any services for treatment paid by you.

Does your Pet(s) have any known health conditions (e.g., Diabetes, Cushing’s, Thyroid, Heart, Epilepsy/Seizures,

Addison’s, Feline Leukemia/Feline FIV, Ehrlichia/Lyme), if so, please state: ___________________________________________________________________

Is your pet(s) currently taking any medication?   Yes_______   No _______

If yes, what medications & instructions: ____________________________________

____________________________________________________________________

Would you like any procedures done while your pet(s) is/are Boarding? (i.e nails trimmed, grooming, and bathing) IF A SURGICAL PROCEDURE IS WANTED YOU WILL ALSO NEED TO MAKE ARRANGMENTS WITH THE CLINIC. OR THE PROCEDURE WILL NOT BE DONE.  (Please list any procedures)

______________________________________________________________________________________________

Feeding Instructions

Changes in pet’s diet can be traumatic to their digestive system. We encourage you to bring your pet(s) food from home to avoid any problems. If you choose not to bring any food we offer Royal Canin Low Fat Digestive dry food free of charge while your pet is boarding. If your Pet does not eat well while here, we may also try offering Royal Canin canned/wet food at your expense.

Type of food and frequency: dry food amount________________frequency per day________________

wet food amount _______________frequency per day________________

Personal Items

Do not bring items with your Pet that are valuable or irreplaceable. Islands is not responsible for loss or damage to any

personal item or toy left with your Pet.

Payment for Services

I authorize Island’s Pet Resort and Island’s Animal Clinic to treat my pet(s) should medical care be required according to the above instructions and to give any vaccine required if I have failed to provide documentation, and I assume full financial responsibility for any medical and/or vaccine charges. I understand that full payment for all services is required when I collect my pet(s). If I neglect to pick up my pet(s) within five days of my intended collection date Island’s Pet Resort may assume the pet(s) is/are abandoned and I authorize the disposal of the pet(s) as deemed necessary and that by doing so does not relieve me of my financial obligations.

Signature ________________________________________ Date _______________

Additional Comments:__________________________________________________________________________

Please know that we are not a 24 hour facility your animal will not be monitored overnight.

Office Use

Kennel Technician that checked animal(s) in: _______________________________