Boarding & Hospital Admission Form

Date

Owner Name*

First NameLast Name

Email*

example@example.com

Cell Phone Number*

Area CodePhone Number

Patient Name*

Species*

DogCat

Breed *

Sex*

Female - IntactFemale - spayedMale - intactMale - neutered

Color and Markings *

Date you are admitting your pet for boarding*

Date

Date and time you are picking your pet up from the hospital. *

DateHourMinutesAM/PM Option

Please list all medications your pet is taking

Do you need any refills

Please list the Flea & Tick Preventive you are using*

Date of the last application of Flea & Tick preventive *

Date

What Heartworm preventive are you using. (dogs)

Date of last dose of Heartworm Preventive

Date

Please Tell us about your pet's diet*

What Type / Name ? How Much ? How Often?

Is your pet experiencing the following?

How long have the symptoms noted above been going on?

Please describe any special care your pet requires. (additional charges may apply)

Please List all of your Pet's Medications

	NAME of MEDICATION	How Much ?	How Often ?
Medication 1
Medication 2
Medication 3
Medication 4

First Person to Contact *

First NameLast Name

Phone Number*

Area CodePhone Number

Relation to You *

Second Person to Contact

First NameLast Name

Phone Number

Area CodePhone Number

Relation to You

Is there anything else you would like us to know?

I, the undersigned, hereby confirm that I am the legal owner / agent of the animal described above. I am authorizing the staff of Hilton Animal Hospital to administer treatment, perform diagnostic and prophylactic procedures, and care for my pet as deemed necessary by the attending veterinarian.

Hilton Animal Hospital or its staff will not be held responsible in any manner whatever or any circumstance, on account of the care, treatment, or safe keeping of the animal described above or otherwise in connection therewith.

I bare full financial responsibility for any and all costs incurred for the treatment and care of my pet, and I am aware that all outstanding accounts are payable in full after services are rendered. Any Account not paid in full will incur finance charges, and possible collection fees, including attorney’s fees.

In the case of an emergency I understand that every reasonable effort will be made to contact me. Until I can be contacted, I hereby direct and authorize the staff and doctors of Hilton Animal Hospital to administer treatment and care to my pet as deemed necessary by the attending veterinarian. I understand that every reasonable effort will be made to treat my pet and I will bare full financial responsibility for any costs incurred.

I have read and understood the statement above and I understand the attached Hilton Animal Hospital Boarding Policy.

Signature*

sign with mouse / sylus or finger

Thank you for choosing our Hilton Animal Hospital to board your pet. We provide quality boarding with a personal touch. Our Staff will make every effort to give each pet individual love and attention during their visit with us. We strive to maintain a safe, sanitary and healthy environment for our patients.

Boarding Policy

In an effort to prevent the spread of infectious diseases and parasites, hospitalized and boarded animals must be current on all vaccinations and free of internal and external parasites.

Vaccinations: All pets must be up to date on their vaccinations, and it is the owner’s responsibility to make sure that proof of current vaccine status is on file with the hospital at the time of admission. *Boarding animals less than five months of age is not recommended because they may not have developed complete immunity.

Dogs: DHLP-PV, Rabies and Infectious Tracheo-bronchitis / Bordetella is required

Cats: FVRC-P and Rabies is required.

Internal/External Parasites: All pets must be free of parasites, including fleas and ticks. We require that all pets have been recently and correctly treated with one of the following products: Revolution, Frontline Plus, Advantage or Advanticks. Any animals with fleas will be treated at the owner’s expense. All dogs that are not currently on a monthly heartworm preventive will be tested for heartworms as well as have a fecal examination for intestinal parasites. * Please note that most topical flea preventives wash off. If a pet has recently been washed after their monthly flea treatment; a new dose of flea & tick treatment will have to be applied.

Spay and Neuter: Hilton Animal Hospital only boards spayed or neutered dogs and cats. An exception is made for pets under 1 year old. Unfortunately our facility is not equipped to board sexually intact animals.

Cats: At Hilton Animal Hospital we love cats. We therefore know that some cats that are not used to dogs can become very stressed when boarding. We want to inform cat owners that we board both dogs and cats in our hospital. Some cats that live in cat-only households may do better at home with a pet sitter.

Medical Illness Policy: One of the advantages of boarding your pet(s) at a Veterinary Hospital is that medical attention is readily available for our guests. If your pet needs medical attention, we will notify you via your emergency contact number. If we are unable to contact you, your pet will be treated, as we deem necessary, at normal hospital fees. If your pet is currently on medication, please inform the receptionist. Charges for administering medications are based on the frequency of dosages and the means of administration.

Aggressive Behavior: In rare cases the stress of boarding may cause a pet to become aggressive. If a pet becomes a danger to itself or the staff, we reserve the right to contact the owner and send the pet home. If there are any doubts if a pet is well socialized or in good health to board, we strongly encourage owners to bring their pet in for a meeting and brief technician evaluation.

Personal Belongings: Leaving personal belongings, i.e.: toys, blankets, bedding, etc., can make your pet’s stay enjoyable. However, we cannot be held responsible for any items becoming soiled, broken or lost. If you have questions about this, please discuss with the admitting technician. Collars and leashes should not be left at any time.

Illness & Inherent Conditions: Occasionally pets may develop medical or behavioral problems from environmental and dietary changes. Signs may include, but are not limited to: vomiting, diarrhea, coughing, sneezing, and self-trauma such as scratching or biting their skin. We take great care so that these problems won’t occur and we treat our guests promptly, if needed. However, please be aware and understand that these conditions can develop and that the hospital is not financially responsible for these inherent conditions, if they do occur.

Severe Inclement Weather Policy: Hilton Animal Hospital is not an inclement weather shelter. The building does not have an auxiliary power source and may be subject to flooding. If a severe inclement weather event is anticipated we will call all owners of boarded and hospitalized patients to come and pick them up ASAP. During the weather event our staff will not return to the hospital until the event has passed and roads are safe to travel. Any animal left in the building will be left alone. If an evacuation order is given for our area, our staff can only return when the evacuation order is lifted.

Abandonment: Please notify us if there is any change of plans in your pet’s scheduled release date. If you do not notify us of a change in your pet’s departure date and we do not hear from you or your authorized agent for a period of 5 days after your pet’s scheduled release date, the Hospital will consider your pet abandoned. We will make every reasonable attempt to contact you. Abandoned pets will be handed over to the city Animal Control Service. Please be advised that the pet owner will be responsible for the fees accrued and any other fees or legal services incurred by the Hospital as a result of the abandonment.

If you have any questions or concerns please feel free to contact us any time. Thank you!

Boarding & Hospital Admission Form

Emergency Contact Information