Boarding Consent Form

Name *

First Name Last Name

Pet's Name *

Phone Number *

Area Code Phone Number

Alternate Phone Number

Area Code Phone Number

Boarding Check In: *

Date

Boarding Check Out: *

Date

Please select any additional services for your pet while boarding: *

Deluxe Bath - prices vary Simply Clean Bath - prices vary Pedicure - $16.75 Anal Sac Expression - $23.61 NONE

Feeding Instructions: Amount to feed *

Feeding Instructions: Frequency *

Once a day Twice a day

Please list any medical or behavioral problems that we need to know about.

Does your pet have thunder phobia? *

No Yes and you may use Benadryl. Yes but I do NOT approve Benadryl.

Has you pet been known to dig under, climb, or jump a fence? *

Yes, dig Yes, climb/jump No

What heartworm prevention is your pet taking? *

Is your pet taking any medications? *

Yes No

If yes, please complete all information for our staff to administer medications while your pet is in our care. All medications are to be in a labeled in a prescription bottle, prescribed for the patient that is currently being administered medications. For the safety of your pet, medications will not be administered or prepared in food or any other container that is not the prescription bottle that is labeled for your pet. There will be a charge of $19.77 for Heartwood staff to separate or place medications in a prescription bottle labeled for the pet being administered medications. Thank you for your understanding and allowing Heartwood Animal Hospital to provide the best care for your pet. There will be a charge of $2.67 per time medications are administered.

	Medication Name	Strength	Instructions (Include AM or PM)	Dose Due Next
Medication 1
Medication 2
Medication 3
Medication 4
Medication 5
Medication 6

Heartwood Animal Hospital is not responsible for any belongings left or damaged while boarding. If you wish to bring any items from home, please limit the items to beds/blankets and food only. *

I understand

Please note there is a 1/2 day charge if your pet is picked up after 2:00pm. This charge does not apply if your pet is getting a bath. *

I understand

After November 1st 2021, Heartwood Animal Hospital will no longer board animals over weekends and holidays. If your pet is has not been picked up by the end of our business hours before the weekend or a holiday, there will be a $150 per night (per kennel) fee added to your account. Initial here *

For your pet’s protection, vaccines must be current: Dog: Rabies, DHPP, Bordetella (Kennel Cough), Fecal Cat: Rabies, FVRCP, Fecal. In the event a fecal exam is not current, Heartwood Animal Hospital will perform a fecal exam at the charge of $29.43, if parasites are found, then medications will be dispensed at owner’s expense. Wellness exam must be current for vaccine updates. All pets must be free of external parasites. A brief examination will be done upon admission to check for fleas, ticks, and ear mites. All pets are given Capstar upon admission at a charge of $6.05 to protect all boarding guests. If a live flea is found on a pet guest that is staying in the hospital over 24 hours, a prescription flea preventative will be administered at owner’s expense. If your pet becomes ill or injured while boarding at HAH, we will do our best to contact you through the phone numbers provided. If you cannot be reached in a timely manner, we will treat your pet at the discretion of our medical staff. All expenses incurred will be your responsibility. Initial here *

I understand that this form is being use to help care for my pet while at Heartwood Animal Hospital. I have double checked this form for accuracy and all I have entered is accurate to the best of my knowledge. *

Clear

Today's Date: *

Date

Please verify that you are human *