Name: Kittery Animal Hospital
Address: 195 State Rd., Kittery, ME, 03904, United States
Telephone: 207-439-4158
Price range: $

Owner's Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Pet's Name *

Species *

If other, please specify *

Arrival Date *

Estimated Arrival Time *

Between 8 am - 10 am, Monday - Saturday (Please call to make special arrangements prior to 8 am)
Between 2 pm - 3 pm, Monday - Saturday

Pickup Date *

Estimated Pickup Time *

Between 8 am - 10 am, Monday - Saturday (Please call to make special arrangements prior to 8 am)
Between 2 pm - 3 pm, Monday - Saturday

Food Options *

Kennel food (Purina EN)
Own food (Please baggie food for each meal and label)

Feeding instructions *

At time of drop off what will pet need for a meal the remainder of that day? *

Will your pet(canine) be attending Day Play? If yes, please fill out the day play application. *

Yes
No

Does your pet have any allergies or MEDICAL CONDITIONS that you are aware of? *

Yes
No

If yes, please explain *

Is your pet on any medications? *

Yes
No

Please note that all medications MUST be original containers and properly labelled with exact dosing instructions. We will not accept or administer any medication that is not in its original container. *

I have read and understand.

Name of medication *

MG of medication *

Dose you are giving of this medication *

What does the bottle say for a dose to give the medication? What diagnosis was given to give these medications? *

Add another medication? *

Yes
No

Please note that all medications MUST be original containers and properly labelled with exact dosing instructions. We will not accept or administer any medication that is not in its original container. *

I have read and understand.

Name of medication *

MG of medication *

Dose you are giving of this medication *

What does the bottle say for a dose to give the medication? What diagnosis was given to give these medications? *

Add another medication? *

Yes
No

Please note that all medications MUST be original containers and properly labelled with exact dosing instructions. We will not accept or administer any medication that is not in its original container. *

I have read and understand.

Name of medication *

MG of medication *

Dose you are giving of this medication *

What does the bottle say for a dose to give the medication? What diagnosis was given to give these medications? *

Add another medication? *

Yes
No

Please note that all medications MUST be original containers and properly labelled with exact dosing instructions. We will not accept or administer any medication that is not in its original container. *

I have read and understand.

Name of medication *

MG of medication *

Dose you are giving of this medication *

What does the bottle say for a dose to give the medication? What diagnosis was given to give these medications? *

Would you like your pet to have a nail trim while here (please know that on holidays this might be unavailable)? *

Yes
No

Would you like your pet to have a To Go Home Bath (includes bath, brush, nail trim, and ear cleaning) Please know this service is performed by our kennel staff and is not considered having a grooming appointment. *

Yes
No

If you would like your pet bathed/groomed by our groomer while boarding, please call us at 207-439-4158 to schedule it ahead of time, as grooming does book fast. If you have already scheduled the groom while boarding, please put the date, it's scheduled. If your pet is being groomed on the day of pick up, plan on picking up in the afternoon when the groomer calls that the services have been rendered.

Do you have a groom scheduled with our professional groomer during your pet's stay with us? *

Yes
No

Please check one of the following canine boarding choices. *

Basic Boarding (Your pet will have a minimum of 3 breaks 30-45 minutes each daily and will not be with other dogs during these times.)
Basic Boarding with Group Play (Your pet will have a minimum of 3 breaks 30-45 minutes each daily to socialize and play with other Boarding and/or Day Play dogs) Please fill out the Day Play Client Authorization Form.
Day Play Boarding (Your pet will be socializing all day with other Boarding and/or Day Play dogs with breaks as needed. Additional fees apply.) Please fill out the Day Play Client Authorization Form.

Scheduled Grooming Date *

Has your pet had any coughing, vomiting, diarrhea, or in juries in the last month? *

Yes
No

If yes, please provide us with more details:

Have you seen any fleas on your pet? *

Yes
No

Is your pet on flea and tick preventative? *

Yes
No

What flea and tick preventative(s) is your pet on?

Is your pet on heart worm/intestinal parasite preventative? *

Yes
No

What heart worm/intestinal parasite preventative(s) is your pet on? *

When was the last preventative administered? *

Is your dog able to have group play? (I, the undersigned, authorize my pet(s) to participate in group play at my own risk and understand that KAH & CC or their staff will not be held responsible for any damages to property or injury to any animals, including my own while they are attending daycare or group play or while boarding at KAH & CC. I am undertaking these activities at my own risk & understand if any medical attention is necessary for my own pet, I agree to take that financial responsibility. *

Yes
No

Does your pet have any belongings with him or her for boarding?

Washable blankets, toys, and special belongings are welcome as long as they pose no threat to the pet. Kittery Animal Hospital ASSUMES NO FINANCIAL RESPONSIBILITY FOR THE CONDITION OF THEIR RETURN OR LOSS.

Who should we notify if your pet becomes ill or injured? *

If the pet becomes ill other than diarrhea and requires veterinary attention, the kennel has permission to seek medical attention with one of our staff veterinarians at the owner’s expense. Owners understand they are assuming their own risk, and Kittery Animal Hospital will not be held financially responsible for any expenses incurred from injury, illness, or exposure to illness during or after a boarding stay.

Accommodations: I hereby entrust Kittery Animal Hospital (KAH) to care for my pet(s) during his/her boarding stay. KAH will use all reasonable precautions against illness, injury, or escape of my pet, but will not be held liable or responsible in any manner whatsoever. (KAH) will provide accommodations deemed appropriate for the safety, health, and comfort of my pet(s). *

I have read and understand

Emergency or Illness: I have provided the above phone number(s) to reach me in case of emergency, or the name and phone number(s) of an alternate contact person who is able to authorize services if I cannot be reached. In the event of an illness or emergency, KAH will attempt to contact me or my alternate contact at the phone number(s) provided; however, I understand that if I cannot be reached within a reasonable length of time, I authorize KAH to treat my pet however is deemed necessary for his/her health and well-being, and I agree to pay for any and all expenses that may be incurred. *

I have read and understand

Signature *

Clear Signature

Boarding Client Authorization Form

Boarding Client Authorization Form

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