Northeast Animal Clinic 10171 Two Notch Rd, Ste F Columbia, SC 29229
Fill out the online form or download the PDF document.
Owner Name *
Email Address *
Drop Off *
Pick Up *
Where we'll be *
Phone number there *
Emergency Contact *
Phone *
Pet(s) Boarding *
Did you bring your own food? * YesNo
Name of Food
Do you feed your pet in * AMPMBoth
Amount per feeding
Did you bring any items (blanket, toys, chews, etc.)?
Is your pet on medication? * YesNo
If so instructions
Medications
Any medical conditions we should be aware of
To insure the protection of all pet(s) under our care, the following requirements must be up to date
I give permission for the Veterinary Clinic to update my pet(s) vaccinations in accordance with the policy below.
Rabies
DHP-P (Distemper/Parvo)
Bordatella (Kennel Cough) done every 6 months
FVRCP (Feline Distemper)
FIV/FeIV combo test
All pets that have fleas on arrival will be administered Capstar at owners expense
One of the advantages of boarding your pet at a veterinary hospital is that the veterinary attention is readily available should the need arise. If your pet becomes ill we will call the emergency number listed above regarding your pet(s) symptoms treatment options and estimate of additional cost. If no one can be reached, please indicate your wishes below should your pet require treatment to relieve immediate discomfort or resolve an important medical condition:
Please perform whatever services the Doctor deems necessary for the best care of my pet until someone can be reached.
I autorize to (tick to select an amount)
$100$250Other $
in medical care for my pet until someone can be reached
DO NOT ADMINISTER any medical treatment until specific authorization is given. (In a life threatening emergency, stabilization procedures will be administered.)
I fully intend to pick up my pet on the specified date above, if circumstances change, I will make new arrangements by contacting the veterinary clinic with new pick up date
Date *
By clicking the submit button below, I hereby agree to and accept the terms and conditions specified above