Name *

First

Last

Email *

Pet(s) Name that has/have a scheduled reservation. If you don’t already have your reservation, please call us at 402-462-2234 to reserve your pet(s) spot now *

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? (More frequent feedings may be available upon request) *

Once per day
Twice per day (morning and evening)
I would like to ask about more frequent feedings

When does your pet get fed? *

Mornings
Evenings

How much 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 and when the next dose will need to be given after drop off. Ex. Carprofen 100 mg – Give one tablet by mouth every 12 hours with food. Next dose is the evening after drop off. *

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

Yes
No

Is your pet experiencing any coughing?

Yes
No

How long has your pet been coughing? *

Is the cough dry or productive? *

What does it sound like? (i.e., hack, gag, etc.) *

Is there any abnormal eye discharge? *

Yes
No

What color? *

Do you have any additional comments that may be helpful to the veterinarian in regards to coughing?

Is your pet experiencing any sneezing?

Yes
No

How long has your pet been sneezing? *

Is there any nasal discharge?

Yes
No

If yes, what color is it? *

Is there any eye discharge?

Yes
No

If yes, what color is it? *

Do you have any additional comments that may be helpful to the veterinarian in regards to sneezing?

Is your pet drinking normally?

Yes
No

Is your pet drinking more or less than normal? *

More
Less

How long has this been going on? *

Do you have any additional comments that may be helpful to the veterinarian in regards to drinking?

Is your pet urinating normally?

Yes
No

Is your pet urinating more or less than normal? *

More
Less

How long has this been going on? *

Is your pet having accidents inside the house/outside the litter pan? *

Do you have any additional comments that may be helpful to the veterinarian in regards to urinating?

Is your pet having normal bowel movements?

Yes
No

What consistency is your pet’s stool? Ex pudding, watery, semi-formed, etc. *

How long has this been going on? *

Is your pet having accidents inside the house/outside the litter pan? *

Yes
No

Is there any blood in the stool? *

Yes
No

Do you have any additional comments that may be helpful to the veterinarian in regards to bowel movements?

Is your pet experiencing any vomiting?

Yes
No

How long have they been vomiting? *

How often is your pet vomiting? Ex. 1-2 times per day, 1 time per month, right after they eat for a week, etc. *

Is there any blood in the vomit? *

Yes
No

What does the vomit look like? *

Has your pet eaten anything abnormal lately? *

Do you have any additional comments that may be helpful to the veterinarian in regards to vomiting?

How has your pet's appetite been?

Normal
Abnormal

Is your pet eating more or less lately? *

More
Less

How long has this been going on? *

Has your pet eaten anything they shouldn’t have recently? *

Yes
No

Do you have any additional comments that may be helpful to the veterinarian in regards to your pet’s appetite?

How has your pet's activity level been lately?

More active
Normal
Lethargic

How long has this been going on? *

Do you have any additional comments that be helpful to the veterinarian in regards to your pet’s activity level?

Is your pet current on any heartworm or flea/tick prevention (administered within the last 30 days)?

Yes
No

Please note that if fleas are found on your pet during their stay we will apply/administer a flea/tick product at your expense.

What product(s) is your pet taking? *

What day (approximately) was it given/applied? *

Do you plan to apply/administer a product prior to boarding? *

Do you have any other concerns? Ex. limping, a mass to look at, vision issues, scooting, etc.

Comments

I understand that I will need to sign an estimate of charges or may have to answer a few additional questions. I would prefer to sign the estimate: *

At the time of drop off. I understand that this means I need to plan for an extended check in time
Via an electronic document signing program which will be emailed to me at the above address after I have completed this questionnaire and approximately 12-24 hours prior to my scheduled drop off.

I confirm that this form has been filled out to the best of my knowledge and if something changes with my pet prior to my scheduled drop off (health concerns, etc), it is my responsibility to notify staff at drop off and I may potentially have to fill out additional paperwork. *

I have read and understand

Boarding Questionnaire

We proudly serve the pets Hastings, NE and beyond.

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Boarding Hours

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