Pleasantville Animal Hospital, New York Veterinarian 914-769-3700 Pleasantville Animal Hospital, New York Veterinarian
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Boarding Form


To ensure the best care possible for your pet, please take the time to complete this form so we have as much information as possible. PAH will use this information to prepare a boarding check in form for you to sign when you bring in your pet. When done, click submit to send the form information to us.
Your Name
Street Address
City, State, Zip
Home Phone

Work Phone

Mobile Phone
E-mail (preferred)
Spouse/Partner Name
Emergency Contact:  
Emergency Contact Name
(if other than spouse)
Emergency Contact's Relation to You
Emergency Contact's Phone
Is this person authorized to make decisions about your pet’s health?  
Reservation Dog Ward
Cat Ward
Own Cage/Food (exotics)
Check In Date
Check Out Date
Pet Name
Species Dog     Cat     Other
If Other Species

Needed Vaccinations
and Tests (if known)

Feeding Hospital Food      Will bring own food
Feeding instructions:

Additional Services

The Royal Treatment Spa Services (includes bath, hair cut, nail trim, ear cleaning, and anal gland expression). Instructions:
  Board & Playtime ($5 per)

Ear Cleaning

  Nail Trim

Anal Gland Expression

  Other (if other please specify:)
Medication Yes       No
Personal Belongings
(All items MUST be labeled with client's last name in permanent marker. We are not responsible for lost, stolen or damaged items and do not guarantee the return of any personal belongings)
List bedding, carrier, leash, collar, other, as appropriate:
Medical Illness In the case of major medical concerns or illness we will attempt to contact you or your emergency contact at the number listed above as soon as possible. In the event that medical care is needed for your pet, please give us guidance on how you would like us to proceed (choose one):
1. I authorize PAH to perform whatever treatments are necessary and accept full financial responsibility for all charges related to the treatment of my pet.
2. I authorize up to $ in medical care during my pet's stay.
3. DO NOT administer any medical treatment until authorization is given, unless denying treatment prolongs suffering to my pet and I cannot be contacted within 1 hour. I then authorize PAH to treat my pet according to the on-duty veterinarian's recommendations up to and including euthanasia. I will accept full financial responsibility for all charges incurred.
  With the above authorization we will treat your pet for minor medical concerns WITHOUT contacting you
When you are finished, click submit to send the form information
Pet Portal Care Credit
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