Broadway Veterinary Clinic - [Boarding Appointment Registration]

	Broadway Veterinary Clinic 1073 South Broadway Lexington, KY 40504 (1) Phone: (859) 255-5595 Fax (859) 254-1359

Boarding Appointment Form

Thank you for requesting an appointment with Broadway Veterinary Clinic. We look forward to meeting all of your veterinary needs. Please remember that your appointment is not final until you receive confirmation from our staff.

Please note: You may be required to sign release forms in our office, as well as provide us with a copy of your pet's vaccination certificates. No reservations are final until you receive confirmation from our staff.

Boarding Policies:
For YOUR pet's protection and those of others, we require all dogs and cats boarding at Broadway Veterinary Clinic to be current on vaccines.

DOGS
Dogs must be current on vaccines against distemper, rabies, bordetlla and parvo.

CATS
Cats must be current on vaccines against Leukemia, rabies and distemper. Pets may be vaccinated upon arrival to the clinic.
Check Out:
Check out time before charges being accuring for the next business day is: 6:00 PM


Owner Information
Salutation
Owner's Full Name
Phone Number	( ) ext
Email Address
Pet Information
Pet Name
Species
Weight
Age
Sex	Male Female
Has your pet been spayed or neutered?	Yes No
Date of most recent vaccination
Services
Drop off Date
between	and
Pickup Date
between	and
Services requested during stay	- Basic Cleaning/Bath - Bath/Flea Treatment - Medicated Bath - Nail Trim - Prescription Refill - Shaving/Dematting - Grooming and Nail Trim - Other
Special Instructions	- Bath before Pickup - Daily Pet Treats - Comfort Cushion - Double Size Accomodations - Medication Administration - Other
Food Preference	- Dry - Canned - Semi Moist - Other
Preferred Method of Flea Control
Please list any medication your pet is currently taking, as well as special needs or pertinent medical history that our staff should be aware of while caring for your pet.
In Case of Emergency
Is there a number we can reach you at while you are away?
Phone Number	( ) ext
Who can we contact locally?
Name
Phone Number	( ) ext
Address
City
State
Zip/Postal Code
Country	United States of America Canada
If you are not an existing client of this clinic, who is your family veterinarian?
Name
Phone Number	( ) ext
Address
City
State
Zip/Postal Code
Country	United States of America Canada

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