Boarding Authorization Form

The following Information is Necessary in the Process of Serving you Better.

Owner's Name*
First Last
Owner's Phone*
Pet's Name*
Drop Off Date*
Date Format: MM slash DD slash YYYY
Pickup Date*
Date Format: MM slash DD slash YYYY
Weight
Emergency Contact Name*
First Last
Emergency Contact Phone*
I Am Leaving:*
- Food
- Carrier
- Leash
- Collar
- Medication
- Other
Special Instructions
Authorization for Immediate Care
In case of an emergency, I authorize the Bend Veterinary Clinic to provide immediate veterinary care and any procedures deemed necessary for the wellbeing of my pet while in the care of the clinic. I also understand that I assume financial responsibility for all services rendered.
*
- By checking this box, I am acknowledging full responsibility for all fees and charges that are incurred during boarding.

Authorization for Immediate Care