"*" indicates required fields

Client Information

Owner's First Name*

Owner's Last Name*

Phone*

Email*

Emergency Contact Name*

Emergency Contact Phone*

Please list the names of others who are authorized to pick up your dog(s)

Authorized Person's 1 Name

Relationship

Authorized Person's 2 Name

Relationship

Arrival Date*

MM slash DD slash YYYY

Departure Date*

MM slash DD slash YYYY

Pick Up Time*

Pet Guest Information

Pet's Name*

Age*

Breed*

Known Allergies

Feeding Information*

Own (from home)

In-House Kibble (Royal Canine GI)

Morning Amount*

Evening Amount*

If your dog is not eating, may we mix in some low fat wet food?*

Yes

Medical Information

Has your dog had any of the following in the last 30 days?*

Coughing

Sneezing

Vomiting

Diarrhea

Rash

Ear Issues

Eye Issues

Please check all that apply

Is your dog currently taking any medications?*

Yes

If yes, please list all medications, dosage and amount*

Playcare

Would you like your dog to participate in playcare during his/her stay?*

Yes

Belongings

Please list all items that you brought with your dog that should be returned to you upon pickup*

Hill Country Veterinary Hospital is to use all reasonable precautions against injury of your pet. The staff will not be held liable for any problems that develop provided reasonable care and precautions are followed. I understand that any problem that develops with my pet while I am absent will be attempted to be communicated to me and will be treated as deemed best by the veterinarian and I assume full responsibility for any cost. If my pet cannot safely adapt to the group play environment, they may be placed in their suite and given individual play time. I agree to allow the use of my pet’s name and any images, including photos or videos of my pet taken while at Hill Country Veterinary Hospital to be used at any time on any media/materials associated with the Hospital.

Signature*

All pets will be given Capstar flea prevention upon entering Upper Paw to ensure the safety of all our pets.

Date*

MM slash DD slash YYYY

Canine Character Profile

Origin of Dog*

Rescue group, breeder, etc

Length of Ownership*

Other Pets in Home*

Age, Gender, Etc

Other People in Home*

Include ages

Ever escaped / jumped fence?*

Yes

Ever bitten a human?*

Yes

Ever had an aggressive incident towards another dog?*

Yes

Health

Any known food allergies?

Any other known allergies?

Allowed to have treats?*

Yes

What brand of food do they eat and how much?*

On any medications? If so, please list

Any major health concerns or medical issues?

On flea/tick preventative?*

Yes

Behavior

Overall temperament?*

Go to dog parks?*

Any specific dislikes?*

Regular exercise? What type?*

Fears?*

Crate trained?*

House trained?*

Favorite toys / activities?*

Areas on body he/she does not like to be touched?*

I have read the policies and procedures of Hill Country Veterinary Hospital. I release HCVH from liability and I have Hill Country Veterinary Hospital permission to medically treat my dog as necessary. I understand that I am responsible for all medical billing associated with such treatment. I also understand the risks of communal socialization and despite reasonable care, unpredictable dispositions of dogs can sometimes lead to injury.

Please type your initials to agree with the above statement*

Medication Addendum

All prescription medications must be brought in their original bottles/packaging with the prescription labels still attached and legible. Over the counter medications and supplements do not require prescription labels. Please ensure you have enough medication for the duration of your pet’s stay. If you are a client of Hill Country Veterinary Hospital, refills can be acquired during your pet’s stay. Hill Country Veterinary Hospital is not able to administer intravenous medications other than insulin.

Name

This field is for validation purposes and should be left unchanged.

Boarding Form

Client Information

Pet Guest Information

Medical Information

Playcare

Belongings

Canine Character Profile

Health

Behavior

Medication Addendum

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care