Medical & Boarding History Form

If your pet gets sick while you are away, we will contact you immediately. Please answer the questions below as accurately as possible so we can best care for your pet.

Does your pet have a history of any of the following illnesses or conditions?

We feed Hills Sensitive Stomach (Chicken & Barley) dog food and Iams cat food. You may bring your pet’s own food/treats, and we will feed your pets according to your guidelines.

I agree that all the above information is correct. I understand that proof of current vaccinations must be provided prior to boarding. Since it is necessary for my pet to be current on all vaccinations listed below, I consent to the administration of any vaccines which are due or cannot be verified.

Required Vaccines:

Dogs:

• Rabies
• Distemper
• Bordetella
• H3N2 (K9 Influenza)
• Leptospirosis (Lepto)

Cats:

• Rabies
• Distemper

We are proud to provide the best care to your pet while he/she is staying with us. Golf Rose Pet Lodge and Golf Rose Animal Hospital comprise Golf Rose Animal Services. Pet Lodge employees are on site from 6:30 a.m. – 6:30 p.m. every day of the week. In the event that your pet needs immediate care, we have the ability to bring your pet to Golf Rose Animal Hospital.

In the event that emergency care is needed, Golf Rose medical staff needs your consent to treat your pet. Please fill in the fields below.

I, as listed above on this form, authorize the Golf Rose Animal Hospital medical staff to
treat my pet in the event of a medical emergency during boarding. If treatment is to
exceed amount written in field below, my verbal consent will be required. I understand
that any medical treatments performed will be in addition to any medical
boarding/hospitalization fees. If there is an emergency, and I cannot be contacted, I
authorize the following people to make medical/financial decisions in my stead.

By signing below, I certify that I am the owner or guardian of the pet/pets described
above, and that I have read all of the statements and agree to the terms and conditions
contained herein.