Patient Medical Boarding Request Form

: CLIENT INFORMATION
Client Name:: First Name:
Last Name:
Address:: Line 1:
Line 2:
City:
Country:
State:
Postal Code:
Email Address:
Phone:
: PATIENT INFORMATION
Cat's Name:
Age:
Breed:
Sex:: MaleFemale
Date Last seen by CSS if known:
: Please note medical boarding is only available to pre-existing CSS patients that have been checked with us in the last 6 months. If you wish to have your cat board at CSS and they have never been assessed by us or if it has been longer than 6 months, they will need to be assessed by one of our veterinarian’s at or prior to boarding.
Dates required for boarding:
Please list any diseases your cat has:
Please list any current treatments the cat is receiving:
: In addition to the above please organize complete patient records from your primary care vets including all results of routine laboratory testing and diagnostic imaging.
: How would you like us to contact you?
Contact me by:: PhoneEmail
: Please note this is a submission for a request for boarding. Our reception staff will contact you to confirm availability.

CLIENT INFORMATION