Alternate ER & Pick-up Name*Phone*Contact Email* Pet Name Canned Dry Treats? Yes No Complimentary Bath (TWO Night Minimum) For Dogs Only Yes No Separate to Feed (for multi dog boarding only) Yes No Special Shampoo? Yes No Nail Trim (extra charge) Yes No Permanent Disabilities? Yes No MEDICATION 1Medications and DosagesAmount/QuantityInstructions : Hours Minutes AM PM AM/PM Already Given Today : Hours Minutes AM PM AM/PM MEDICATION 3Medications and DosagesAmount/QuantityInstructions : Hours Minutes AM PM AM/PM Already Given Today : Hours Minutes AM PM AM/PM MEDICATION 4Medications and DosagesAmount/QuantityInstructions : Hours Minutes AM PM AM/PM Already Given Today : Hours Minutes AM PM AM/PM MEDICATION 2Medications and DosagesAmount/QuantityInstructions : Hours Minutes AM PM AM/PM Already Given Today : Hours Minutes AM PM AM/PM (Office use ONLY) Medications approved byBehavioral Concerns? (Aggressive, doesn’t like other dogs or cats, chews or destroys bedding or toys) Yes No Is your pet on a monthly Preventative? Yes No Text Updates (If you have opted out of SVVS texting, you will not receive these updates) Yes No Has your pet been sick, hospitalized or out of the state of VA in the past 30 days? Yes No Any other special instructions (feeding, play time, etc)?*ONLY bring your pets medications and food during this stay. SVVS will take care of the rest. *Unless paperwork is signed that states otherwise, in the case of an emergency while under our care, the doctor(s) will take all measures to stabilize your pet at your expense until you are able to be reached. *ALL animals must be free of external parasites (ex. ticks, fleas, etc.), up-to-date on all required vaccines and an exam within 6-12 months (depending on age and health concerns) at owner's expense. *If I neglect to pick up within 5 days of scheduled departure and have not contacted SVVS then they will assume abandonment. SVVS is then authorized to dispose of my pet as they see fit. I understand that abandonment does not release me from my obligation to pay. *Sunday pick up will be between 4:30-5:00 PM.Doctor exam requested Yes No Nail trim Yes No Ear cleaning Yes No Anal sac expression Yes No Bath Yes No Grooming Yes No Please List Any Concerns that You May HaveIf my pet is not eating well while away from home, it is ok to entice them with flavor additives Yes No Beds/towels are Ok to leave with my pet for comfort (note that some pets may chew and ingest pieces which may be a danger to their health) Yes No I am leaving personal belongings with my pet. Please list (and limit items to one blanket and one toy per pet)(Unless otherwise instructed, your pet will receive Hill’s Science Diet. Prescription diet that may be used to tempt a pet to eat or to calm an irritated bowel will be charged at regular rates). I want my pet to receive INDIVIDUAL PLAY TIME at an additional cost per session.How many days?Preferred activitiesI want my pet to receive a treat at night at an additional cost per night. How many nights?Dogs Dental chew or treats Kong with peanut butter and treats Kong with wet food and treats Cats Catnip toy Tuna treats (Crunchy) Canned Tuna Noted Health ConcernsLast flea preventative dose and typeLast heartworm preventative dose and typeNameThis field is for validation purposes and should be left unchanged.