Client Information

Owner's Name *

First

Last

Date *

Primary Phone *

Secondary Phone

Email *

Emergency Contact *

First

Last

Emergency Contact Phone *

Pet Health History

Pet's Name *

Vaccinated

Yes
No

When/Where

Current Medications your pet is taking:

Can we feed clinic food (Science Diet Sensitive Skin and Stomach)?

Yes
No

Pet's Food:

How often is your pet fed?

Amount fed:

Is your pet a picky eater?

Yes
No

Is your pet known to shred blankets/newspaper?

Yes
No

Are you comfortable with your pet not being provided a blanket:

Yes
No

You understand Corbin Animal Clinic LLC is not responsible for foreign bodies from the consumption of shredded material.

Does your pet get stressed and not eat at times?

Yes
No

Does your pet need medication for anxiety?

Yes
No

Additional Services: (please check all that you want done)

Pet Flea/Tick Prevention

Last time pet was given flea/tick prevention

Does she/he have any aggression towards people, other animals, or in cage?

Yes
No

Does your pet have any personal items? If so, please list and describe items:

Authorization

I authorize Corbin Animal Clinic to take photos of my pet(s) and use for any lawful purpose, including, publicity purposes, illustration, advertising, and web/social media content.

Yes
No

Is there anyone in the household that has a peanut allergy that would require us to not potentially use peanut butter during an exam to make a pet focused?

Yes
No

Who will be picking up your pet?

Fees are charged on a per night basis. Pets are released only during normal business hours. Animals will not be released until services are paid.

I understand that Corbin Animal Clinic LLC does NOT perform overnight care, and will provide staffing for weekend care and other instances when the office is closed.

I understand that I will that I will be contacted in case of emergency. However, if I cannot be reached I authorize Corbin Animal Clinic LLC to perform lifesaving treatment on my pet. I also understand that I will be responsible for all financial charges that may occur with this. I do not hold Corbin Animal Clinic LLC responsible for any injuries or illnesses suffered by my pet.

I release Corbin Animal Clinic LLC from any liability due to loss of my pet(s) blankets, toys, bowls, containers, leashes, beds, and anything else I elect to bring with my pet while staying at their facility for boarding.

I understand that Corbin Animal Clinic LLC does require that my pet be on flea/tick prevention for the protection of my pet and other boarders. If my pet is not current on veterinary dispensed flea/tick prevention, Corbin Animal Clinic LLC will apply medication at an extra charge.

I have given accurate information about my pet(s) to the best of my knowledge. I have also read and understand all above statements.

Signature (must be 18 years or older):

Clear Signature

Date

Online Forms

Pet Boarding

Pet Boarding Form

Client Information

Pet Health History

Authorization

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Address

Contact

Hours