Spa & Resort Questionnaire

CCAC Spa & Resort Boarding Intake At Country Club Animal Clinic

Please enter your pet’s information

Owner's Name *

Pet's Name

Address

Date of Admission (mm/dd/yyyy)

Time

Discharge Date (mm/dd/yyyy)

Time

Home Phone

Business Phone

Pet’s Breed & Color

Item’s Left with Pet

Food Brought In

Any Food Allergies

To the best of your knowledge, is your pet ok in heat?

Yes

Is your dog on flea/tick prevention?

Yes

If no, which do you prefer

Chewable

Topical

For your pet’s protection, all vaccines must be current, including: Rabies, DHPP and Bordetella. Puppies must have finished their series prior to boarding. Your pet must be on a flea & tick preventative, otherwise it will be provided at the owner’s expense. Country Club Animal Clinic is not responsible for any belongings left with your pet. If your dog is in heat, they will be kept in their suite, other than being taken out to use the bathroom. You allow CCAC to take photos and videos of your pet and post them on social media. When you take your pet home your pet may be unusually excited or anxious and possibly have some diarrhea. Your pet may also experience some short term behavior changes and loss of appetite. This is all normal. We do recommend that you schedule a bath; brush and nail trim before picking up your pet.

Days & Hours for Pickup & Drop-Off: Monday – Friday 8:00am – 6:00pm; Saturday & Sunday 9:00am-11:00am or 2:00pm-4:00pm. There is a $1.00 per minute charge for any pet not picked up by closing time at 6:00pm, Mon-Fri and 4:00pm on Saturday & Sunday. Any dog not picked up within 15 minutes of closing time will have to be picked up the next day and will incur an additional 1 day boarding fee at the current boarding rate plus a charge for dog food, if provided by CCAC.

Daily Rates:

1 dog, 1 night

$45.00/night, for the first 3 nights

1 dog, 1 night, (after 3 nights)

$30.00/night, after 3 nights

2 dogs, 1 night

$65.00/night for the first 3 nights

2 dogs, 1 night (after 3 nights)

$50.00/night, after 3 nights

If no, which do you prefer (discount included for boarding with us)

Bath, Brush and Nail Trim

$28.00 - $40.00

Owner's Initial:

Nail Trim

$15.00 - $20.00

Owner's Initial:

Webcam access with treats included

$10.00

Owner's Initial:

*You will have access to our Pet Chatz camera system to talk to your pet and offer treats.

Webcam access with treats included

$10.00/day/dog

Owner's Initial:

Dog Food Provided by Resort

$37.52 - $48.76
for 6-7# bag

Owner's Initial:

IF your dog runs out of food while boarding with us we will provide them Royal Canin GI Low Fat or Hill’s i/d low fat; or Royal Canin HP for dogs with allergies.

IF your dog is not eating we will top their food with Royal Canin GI Low Fat or Hill’s i/D Low Fat canned food to stimulate their appetite, which is $3.75/can. Owners will be responsible for the cost offood provided.

Name of Medication

Dose

This information is accurate to the best of my knowledge. I understand that Country Club Spa & Resort will make decisions that affect the care and safety of my dog, other dogs, and the staff based on this information, and that it is my responsibility to update the information as I am aware of changes.

Name of Your Veterinarian:

Phone Number

Emergency Contact

Phone number

Owner’s Signature *

Date *