Boarding Drop Off Form

Client Name

Pet's Name

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

Contact's Phone Number

Drop-Off, Arrival Date

Pick-up, Departure Date

Your Pet's Species

Dog Cat Other

Pet Description

Feeding Instructions, Frequency and Quantity

Which food would you prefer that your pet eat?

Our Kennel food Food from home

Brand and Type of Food given at home:

Does your pet chew or eat blankets or bedding?

Yes No

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 No

Please explain

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

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 No

Name of the Brand of Heartworm Medicine:

Is your pet given Flea and Tick prevention medicine regularly?

Yes No

Name of the Brand of Flea and Tick Medicine:

Add a refill:

Heartworm Prevention Medicine Flea/Tick Prevention Medicine Other

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

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?

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

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

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.

Signature

Pre-Treatment Consent and Authorization

$75 Off Your Pet’s First Wellness Exam