At Westwood Veterinary Hospital, we offer patient forms online so you can complete them in the convenience of your own home or office. Client Name:*Reachable Number*Patient Name:*SpeciesBreedColorSex (include whether spayed/neutered)AgeBirthdayAre your pet’s vaccines up to date? If yes, please indicate which vaccines and when last given.If not, please indicate below which treatments you would like your pet to receive. Canine: Exam Rabies vaccine (required) DHLPP vaccine (required) Bordetella vaccine (required) Rattlesnake vaccine Heartworm test Fecal test Feline Exam Rabies vaccine (required) FVRCP vaccine (required) Feline Leukemia vaccine Heartworm/FIV/Leukemia test Fecal test Any vomiting, coughing, sneezing, or diarrhea?Is your pet allergic to any drugs? If so, what?Has your pet had any illness or injury in the past 30 days?Is your pet currently on any medication? If so, what?Current DietSpecial Feeding InstructionIf any problem should arise while your pet is in our care: You have my permission to treat my pet as required without contacting me or my emergency contact. You have my permission to perform only emergency and supportive care. Notify me for permission to begin any other treatment. You do not have my permission to treat my pet without contacting me or my emergency contact. If any external or internal parasites are found on your pet while in our care, they will be treated at your expense. I understand there is an additional charge for any pet deemed aggressive during the boarding period. I will call if my “pick-up date” changes so you can plan accordingly. If I neglect to pick up my pet within 5 days of the date scheduled for discharge, and do not notify you within that time period, you may assume that the pet is abandoned and are hereby authorized to dispose of the pet as you deem best and/or necessary.Owner:*Date* MM slash DD slash YYYY Emergency contactEmailThis field is for validation purposes and should be left unchanged.
