Meadow Hills Veterinary Center. P. S.
8802 W. Gage Boulevard ~ Kennewick, Washington 99336 ~ (509) 783-0399
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Client ID ____________ Return to Forms |
Pet's Name:_______________________________________ Dog/Cat (circle one) Altered Yes/No Age________
Date of Admission:____________ Discharge Date:___________ Articles Left:____________________________
Owner's Name:___________________________________________ Home Phone: ______________________
Health problems of pet:____________________________________________________________________
Medication (please include name of medication, times to be given and dosage) _________________________
_____________________________________________________________________________________________________
Emergency contact (please provide telephone number where you can be reached or give us the name of a person who can make decisions regarding your pet in your absence.)
Name:____________________________________________________ Phone # ________________________
Vaccination Dates:
Dog DHLPP-C: _______________ Bordetella: _______________ Rabies: _______________
Cat: FVRCP: _________________ Rabies: _________________
| Cats | Dogs |
| Feline Apartment $14.00/day _________ | Puppies (under 4 months) $16.00/day _________ Canine Residents (small) $18.00/day __________ |
| Feline Condo $19.00/day _________ | Canine Residents (medium) $20.00/day _________ Canine Residents (large) $22.00/day __________ |
| Diet: Growth_____ Adult_____ Other_____ | Diet: Growth_____ Adult_____ Senior_____ Other_____ |
Additional "Special" Service (Please Initial)
| _______ Nail Trim - $16.75
_______ Cleansing Bath - $15.00-Short-coated breeds only |
_______ Medication Fee - $4.00/Day- minimum |
| Pets who stay 7 days or more get a free cleansing bath. Short coated breeds only | |
| Tender Loving Care Package | Cost $7.00 # of Times________ |
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| Package Includes: | Brushing Coat and Teeth
15 Min Extra Hand Walking or Play Extra Tender Loving Care Extra Attention |
I hereby authorize Meadow Hills Veterinary Center, P.S. (MHVC) to board my dog/cat for the period of time noted above. MHVC agrees to provide a clean kennel or run for my pet and regular feeding as requested. Dogs will be exercised daily. If emergency veterinary care should become necessary for my pet, I authorize MHVC to provide the veterinary care required and agree to reimburse MHVC for all charges so incurred at the time my pet is discharged.
| _____________________________________ | ___________________ | |
| Name | Date |
| In consideration of Meadow Hills Veterinary Center, P.S. accepting my pet for boarding, I do hereby release, discharge and waive claims, demands, and/or actions against Meadow Hills Veterinary Center, P.S., its agents, employees, officers and insurers arising from or relating to injury, illness or death that may occur during the period of boarding. | Initials ____________ |