Boarding

Millhopper Veterinary Medical Center

Dr. Richard A. Goldman & Associates

4209 NW 37th Place, Gainesville, FL  32606

352-373-8055

Boarding Information                

Pet's Name_________________________

Owner's Last Name__________________

Date In__________  Out___________

Breed_____________________________

Color__________ Sex______Age_______

Pet's Belongings_____________________

__________________________________
                                                                        When does your pet eat?

a.m. /  p.m.     Amount____________

Own food?________________________

Bath?     Yes     No        Date:__________

Additional Services requested? (nail trim, vaccinations, etc.)__________________ ________________________________     ________________________________

Medications to be given while your pet is here:

1. Name___________________________

Dosage ___________________________

    1          2          3      times daily
a.m. / p.m.      ___________________

2. Name___________________________

 Dosage ___________________________

    1          2          3    times daily
a.m. / p.m.      ___________________

3. Name___________________________

 Dosage  ___________________________

    1          2          3      times daily                       a.m. / p.m.      ___________________ 

4. Name___________________________

 Dosage ___________________________

    1          2          3       times daily                      a.m. / p.m.      ___________________

If sedation is necessary for treatment or handling, I give my permission to MVMC to administer such medications at my expense.  All pets entering the hospital must be up to date on vaccinations and free of external parasites (fleas, ticks, etc.) or they will be treated and bathed upon admission at owner's expense.  I also authorize MVMC to do whatever is necessary in the best interests of my pet should an emergency situation arise.  Payment is required when the pet is discharged.  Pets are released only during regular Doctor's hours unless otherwise arranged and prepaid in advance.  If I neglect to pick up my pet within 5 days of the date above and do not contact you, you may assume that the pet is abandoned and you are hereby authorized to dispose of the pet as you deem best and necessary according to Florida law.

 

Signature________________________________________ Emergency Phone #___________________________

For your security, if someone other than you may be picking up your pet from our kennel, please be prepared at the time of drop-off to list their name and phone number. If your furry or feathered friend boards frequently, you may leave a list of authorized parties on file with us.  Remember--payment is due at the time of discharge, so please pay in advance if you will not be picking up your pet in person. Thanks!