TERRA LINDA VETERINARY HOSPITAL - BOARDING AGREEMENT
4230 Redwood Hwy
Phone: (415) 479-8535
San Rafael, CA  94903
Fax: (415) 479-0106
Today's Date________________________       Date of pick-up________________________ [   ]AM  [   ]PM
Owner________________________________________________________________________________

                  Name of Pet                  
      Bathe        
    Medications  
  
  [   ] Yes    [   ] No  
  [   ] Yes    [   ] No  
  
  [   ] Yes    [   ] No  
  [   ] Yes    [   ] No  
  
  [   ] Yes    [   ] No  
  [   ] Yes    [   ] No  
  
  [   ] Yes    [   ] No  
  [   ] Yes    [   ] No  

Person(s) to contact in case of emergency_____________________________________________________
Emergency telephone number(s)____________________________________________________________
Pet's belongings (carrier, leashes, etc.)________________________________________________________
Special Instructions - Include detailed medication directions, feeding instructions and anything you wish the doctor to check for:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

VACCINATION POLICY

to insure the protection of all pets under our care, the following must be up-to-date:

DOGS
_____Rabies       
_____DHLPPC       
_____Bortedella       
_____Stool Exam (within last 6 months)       
CATS
_____Rabies       
_____FVRCP         
_____Stool Exam (within last 6 months)       

If not up-to-date, or unable to provide proof of vaccination, I give my permission to update my pet(s) vaccinations in accordance with the above policy.  In addition, if any fleas/ticks are observed on your pet(s) while boarding, he/she/(they) will receive a flea bath/dip at the owner's expense.

MEDICAL ILLNESS POLICY

One of the advantages of boarding your pet(s) at a veterinary clinic or hospital is that veterinary attention is readily available should the need arise.  If your pet(s) becomes ill, we will call the emergency number(s) listed above regarding your pet's symptoms,  treatment options and estimate of additional costs.  If no one can be reached however, please indicate your wishes below should your pet(s) require treatment to relieve immediate discomfort or to resolve an important medical condition.

  _____Please perform whatever services the doctor deems necessary for the best care of my pet until
            someone can be reached.  This includes only non-elective treatments and necessary diagnostics.

  _____I authorize up to (check one and indicate amount)         [   ] $______         [   ] $100         [   ] $200
            in medical care for my pet(s) until someone can be reached.

  _____Do not administer any medical treatment until specific authorization is given.

I have read and understand this agreement.  I fully intend to pick up my pet(s) on the above specified date.  If circumstances change I will notify the veterinarian of a new pick-up-date.

_______________________________________________________     ___________________________
                               Signature of Owner/Agent                                                       Date