Boarding Drop Off Form

Your Information

Client Name *

First and Last

Pet's Name *

Person Dropping-Off and/or Picking-Up Your Pet

First and Last name, If different from client

Contact's Phone Number

Drop-off, Arrival Date *

Pick-up, Departure Date *

Your Pet's Species *

Canine, Dog

Feline, Cat

OtherOther

Pet Description

Briefly describe info such as breed, color, etc

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Feeding Instructions

Feeding Instructions, Frequency and Quantity *

How much and how often do you feed your pet? Example 1 Cup, 2 times per day

Which food would you prefer that your pet eat? *

Our Kennel food

Food from home

Brand and Type of Food given at home:

Please describe the food you are bringing, e.g. Purina Senior, dry food

Does your pet chew or eat blankets or bedding? *

Yes

Why we ask: If your pet has a tendency to chew on or tear apart blankets, we will not put any bedding in the kennel with your pet for their safety.

Is your pet sensitive or allergic to any medications or food? *

Yes

Please explain: *

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Special Conditions and Medications

Current Medications, Vitamins, or Supplements, and instructions while boarding

Include name, amount (dose), last dose to be given before arrival and frequency of use for all medications, including over-the-counter medicines.

Feel free to describe any health conditions, behavioral concerns, or recent medical issues that we should be aware of during your pet's stay.

Is your pet given heartworm medicine regularly? *

Yes

Name of the Brand of Heartworm Medicine:

Is your pet given Flea and Tick prevention medicine regularly? *

Yes

Name of the Brand of Flea and Tick Medicine:

Add a refill:

Heartworm Prevention Medicine

Flea/Tick Prevention Medicine

OtherOther

If choosing Other, please include name of the medications and the dosage

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Additional Care

Would you like to add any of the following pet grooming services?

Bath: Shampoo, Rinse, and Brush Out.

Nail Trim, Pet Pedicure

Anal gland Expression (rear-end scoot solution)

Would you like to add a medical examinations to your pet's boarding stay? Exam fees apply:

Examination, Checkup, or Symptom evaluation

Vaccinations

Laboratory Test - Annual blood screening, health screening

All animals admitted must be current on Rabies, distemper, Bordetella, and Canine Flu vaccines, as well as testing negative for a fecal test within the last six (6) months.

Which medical concerns that you would like a doctor to evaluate during the examination?

Please describe any problem(s) your pet is having (ex. vomiting, diarrhea, inappetence, lethargy, new lump or mass and location, etc.)

Which vaccinations would you like us to give your pet during their stay with us?

Rabies

Canine Distemper-Parvo

Canine Lepto

Canine Lyme

Canine Bordetella

Canine Influenze

Feline Distemper (FVRCP)

Feline Leukemia

I'm not sure. We will check your records and let you know. Fees may apply.

Which Laboratory test would you like us to perform during your pet's stay?

4Dx (Heartworm, Lyme, Ehrlichia, Anaplasma)

Fecal Test

*Annual Wellness Labwork

Other

*Refer to your Wellness Panel Information Packet or Call Us with Questions

Pre-Treatment Consent and Authorization

I, the undersigned owner, authorized agent of the owner, or Good Samaritan responsible for seeking veterinary care for the pet(s) identified in this form, certify that I am over eighteen years of age, and hereby consent to the examination of this pet by staff veterinarians.

I also agree that after consulting with me, the hospital’s doctors may prescribe medication for, treat, hospitalize, sedate, anesthetize and/or perform surgery on this animal. I understand that some risks always exist with anesthesia and/or surgery and that I am encouraged to discuss any concerns I have about those risks with the attending veterinarian before the procedure is initiated. Should some unexpected life-saving emergency care be required and the attending veterinarian be unable to reach me, this practice’s staff has my permission to provide such treatment and I agree to pay for all related fees. I accept that veterinary medicine is an inexact science and that no guarantee of successful treatment has been made.

I understand that an estimate of the costs for veterinary services will be provided to me by request and that I am encouraged to discuss all fees attendant to such care before services are rendered and during this pet’s ongoing medical treatment.  If this animal is hospitalized, I agree to pay a deposit of 50% of the estimated fees and assume financial responsibility for the balance  of all services rendered on a cash or credit card basis at the time the pet is discharged from the hospital.   In the event the pet is hospitalized for more than twenty-four hours and the attending doctor is unable to reach me, I understand it is my responsibility to call the hospital at least every twenty-four hours to inquire as to the medical status of my pet and the fees incurred for medical services up to that day.

Treatment Costs *

Regardless of cost, treat my pet if any abnormalities are found during the exam.

Call me prior to treatment to share exam findings and cost information

Call me only if costs are expected to exceed $Call me only if costs are expected to exceed $

Treatment Costs are costs that are in addition and separate from the examination fee

Agreement to Terms *

I understand that checking this box constitutes a legal signature confirming that I have read, understand, and agree to the statements above.

Get a copy of this form emailed to:

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If you are human, leave this field blank.

Boarding Drop Off Form

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