"*" indicates required fields Client Name* First Last Pet Name*Check in Date MM slash DD slash YYYY Check out Date MM slash DD slash YYYY Will you be available by phone? YES NO If yes, What is the best phone number to reach you at?Emergency ContactEmergency Contact Phone#AM FEEDING INSTRUCTIONSPM FEEDING INSTRUCTIONSMedication InstructionsMedicationDoseAM or PM? Add RemoveSpecial instructionsPlease list ALL personal items brought for your petWill your pet be getting any services/treatments while here? Please list belowWhat is the maximum dollar amount you authorize for emergency medical treatment during your pet's boarding stay?I understand that any personal items I have brought for my pet may be lost and I will not hold Martinez Animal Hospital liable for these lost items.* I agree to the privacy policy.I understand that I am boarding my pet at a hospital, and I acknowledge that there may be contagious pets on the premises. Although stringent measures are in place to minimize the risk of transmission, complete isolation cannot be guaranteed. I understand that there will be times when no personnel are on the premises. I understand that if medical treatment is deemed necessary during my pet's stay, including annual exams, required vaccines or treatment for active flea infestation, it will be provided. Efforts will be made to contact me about care and associated fees. I am responsible for all charges for necessary medical care. I agree to pay all charges for services provided by Martinez Animal Hospital upon discharge of my pet. Payments can be made by most major credit cards, Care Credit or cash. A credit card processing fee of up to 3% will be applied to all transactions made using credit/debit cards.Signature*Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
