Name *

First

Last

Email *

Pet(s) Name that will be boarding *

My pet(s) will be boarding the following day(s) *

Will we be feeding the clinic's iVet food, or will you be bringing your own food. If you will be bringing your food, what type of food is it? *

How much and how often would you like your pet fed? *

Is your pet on any medications, vitamins, herbal supplements, etc?

Yes
No

Please list the medications and dosages to be given while in boarding *

Does your pet need to have vaccinations updated or need to see a veterinarian for anything?

Yes
No

Is your pet experiencing any coughing or sneezing?

Yes
No

If yes, explain *

Is your pet drinking and urinating normally?

Yes
No

If yes, explain *

Is your pet having normal bowel movements?

Yes
No

If no, explain *

Is your pet experiencing any vomiting?

Yes
No

If yes, explain *

How has your pet's appetite been?

Normal
Abnormal

If abnormal, explain *

How has your pet's activity level been lately?

Normal
Abnormal

If abnormal, explain *

Is your pet current on any heartworm or flea/tick prevention?

Yes
No

If yes, what product *

What is the primary reason your pet needs to be seen?

Do you have any other concerns?

If my pet(s) were to have a health issues needing emergent attention while in Companion's Choice Animal Hospital's care: *

I prefer to be notified by text message while I am away. I understand that the text line is not checked after hours and should not be used as an alternative to calling 402-462-2234 in cases of emergency to contact a veterinarian or team member
I prefer to be notified by a phone call while I am away
I prefer not to be contacted while I am away and authorize Companion's Choice Animal Hosptial to perform treatments based on my selection below.

Best Contact phone number and name while your pet is boarding with u *

Comments

While my pet is in Companion's Choice Animal Hospital's care: *

I wish to have all means used to treat my pet(s). I understand that I am responsible for any charges that may accrue during treatment of my pet(s).
I wish for my pet to be stabilized until I can be reached. I understand that I am responsible for any charges that may accrue during stabilization of my pet(s).
I wish for no measures or treatment to be taken for my pet(s). I understand that failure to recieve medical attention may result in death of my pet(s).

I understand that when I drop my pet off, I will still need to sign an estimate of charges and may have to answer a few additional questions. I also understand that if fleas are found on my pet(s) treatment will be administered at my expense. *

I have read and understand

Boarding Questionnaire

We proudly serve the pets Hastings, NE and beyond.

Contact

Location

Hours

Boarding Hours

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