Owner information   (*)  Denotes required entries

*First Name
Middle Initial
*Last Name
* Address Line 1
Address Line 2
* City
* State
* Zip Code - 
*Home Phone
Work Phone
E-mail

Your veterinarian

First Name
Middle Initial
Last Name
Veterinary clinic
Phone

Emergency contact

First Name
Middle Initial
Last Name
Phone


Desired Boarding Dates (MM/DD/YYYY)

*From

Drop in AM or PM  
*To
 Pick up before noon  

First Pet
General information

*Name

Type
Sex
*Breed
*Neutered/Spayed
Date of Birth              
Special Diet
Number
of feedings a day
Amount
Medications
Health Concerns

Additional Comments

Please enter any additional information you think may be useful below.  For dogs, in particular, we also would like to know:

  • Does your dog exhibit any behavior we should know about?
  • Does your dog bite while in the car? if touched? or under any other conditions?


For Dogs Only

Does your dog jump over 6-8ft fence?

  Yes  No  
Is your dog a digger?   Yes  No
Is your dog a biter?   Yes  No
Does your dog get along with other dogs?   Yes  No
Can your dog be placed outside with other dogs?   Yes  No
Has your pet been boarded before?   Yes  No

Vaccinations

We require a veterinary certificate showing current vaccinations for all pets.
Please Fax or bring a copy of your records.  Enter Expiration Date of shot where applicable or leave blank otherwise.

Dogs

Select Expiration date

(MM/DD/YYYY)

Cats

Select Expiration date

(MM/DD/YYYY)

DHLPP (distemper/parvo) Feline Leukemia (1)
Rabies Rabies
Bordetella (2) FVCRP (distemper)


(1) We require the Leukemia shot, not a test for Leukemia
(2) Now required every 6 months

Is your pet on flea prevention?     Yes   No

When your pet is dropped off, an assessment is done which includes an inspection for fleas. If your pet has fleas, they are given a bath and treated with Advantage at your cost.

Extra services

Group Swim (weather permitting)
Yes   No
Group Playtime
 Yes   No
Nature Walk
Yes   No
Cuddle Time
 Yes   No

Second Pet

General information

Name
Type
Sex
Breed
Neutered/Spayed
Date of Birth    
Special Diet
Number
of feedings a day
Amount
Medications
Health Concerns

For Dogs Only

Does your dog jump over 6-8ft fence?   Yes    No
Is your dog a digger?   Yes    No
Is your dog a biter?   Yes    No
Does your dog get along with other dogs?   Yes    No
Can your dog be placed outside with other dogs?   Yes    No

Has your pet been boarded before?

  Yes    No


Vaccinations

We require a veterinary certificate showing current vaccinations for all pets.
Please Fax or bring a copy of your records. Enter Expiration Date of shot where applicable or leave blank otherwise.

Dogs

 Select Expiration date

(MM/DD/YYYY)

Cats

 Select Expiration date

(MM/DD/YYYY)

DHLPP (distemper/parvo) Feline Leukemia(1)
Rabies Rabies
Bordetella (2) FVCRP (distemper)

(1) We require the Leukemia shot, not a test for Leukemia
(2) Now required every 6 months

Is your pet on flea prevention?   Yes No

When your pet is dropped off, an assessment is done which includes an inspection for fleas. If your pet has fleas, they are given a bath and treated with Advantage at your cost.

Extra services

Group Swim (weather permitting)
Yes   No
Group Playtime
 Yes   No
Nature Walk
Yes   No
Cuddle Time
 Yes   No

Additional Comments

Please enter any additional information you think may be useful below.  For dogs, in particular, we also would like to know:

  • Does your dog exhibit any behavior we should know about?
  • Does your dog bite while in the car? if touched? or under any other conditions?


Miscellaneous

We encourage you to bring personal items. Please write your pet's name along with your last name to each item.  No rawhide toys or chocker collars.

Julington Creek Animal Hospital • 12075-100 San Jose Boulevard • Jacksonville, Florida 32223 • ph. (904) 268-6731 • fax (904) 262-2870 • email: sysadmin@jcaw.com
Hours of operation: Monday to Friday 7.30am - 6pm, Saturday 8.30 - 1.00. Doctors see patients Monday to Friday 9am-11.30am / 2pm-5.30pm, Saturday 9am - 12.30pm.

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