Boarding Admission Form & Consent

Your Full Name *

First Name Last Name

Pet's Name *

Check-In Date *

Date

Check-Out Date *

Date

Please confirm your e-mail address *

Cell Phone Number *

Area Code Phone Number

Secondary Emergency Contact Number *

Area Code Phone Number

Would you like us to send complimentary text messages while you are away? *

Yes No

Phone Number for text messaging

Area Code Phone Number

We recommend that you bring your pet's normal diet in with you to avoid any upset stomachs. For convenience, it is acceptable to premeasure the food and place in baggies or containers.

NOTE: In the event that the amount of food you supply runs short and we need to replace the same food, there may be additional fees, such as with specialty or prescription diets.

Please select one: *

What type/brand of dry food does your pet normally eat? Please be specific. *

If not applicable type n/a

What type/brand of canned food does your pet normally eat? Please be specific. *

If not applicable type n/a

How much food do you feed your pet? If both canned and dry, indicate how much of each. *

How often do you feed your pet? *

Please describe your feeding routine: *

Is there any food your pet cannot have? If yes, please list. *

If your pet decides to be a finicky eater during his/her stay we may use enticement measures. This can include: chicken, broth, canned food, peanut butter, cheese whiz. Please note if this is not ok for us to do.

For multiple dogs staying in the same suite:

Please separate while feeding There are no issues if they eat together

Please list any health concerns we should be made aware of: *

Have you seen any fleas or ticks on your pet in the last (2) weeks? Note: in the event your pet has fleas noted upon admitting, you will be charged for a dose of fleas prevention that we will administer upon check-in. *

Yes Yes, but I have treated my pet No

We are happy to give your pet his/her medications as long as they are in their original container with instructions/label.

We charge an additional $2-3/day to medicate.

Is your pet currently taking any medication? *

yes no

Medications my pet takes (click in first brown box to begin entering):

Name of Medication

Amount

How Often & When

Medication #1

Medication #2

Medication #3

Medication #4

Medication #5

Medication #6

Describe the best method of giving your pet medications:

Do any of the following apply to your pet: *

Does not get along with other animals May exhibit signs of food aggression May exhibit signs of territory/cage aggression Has bitten a person or animal None of the above apply

Does you pet display fear or anxiety to any of the following: *

Thunderstorms Loud Noises Separation Anxiety None of the above apply

In the event your pet exhibits moderate-high levels of anxiety while staying with us, we may administer anti-anxiety medications that help your pet to relax and better enjoy his/her stay. The medications we use are prescribed by a veterinarian and are very safe. Do you have any concerns with us administering, should the need arise?

YES I have concerns that I'd like to discuss NO please use your medical judgment NO please call first, if possilbe.

We provide items such as toys, beds, blankets, food bowls. If you bring any of your pet's belongings from home, you do so at your own risk. We will make every effort to assure they are not misplaced but can not make guarantees.

Note that due to COVID-19, we are discouraging any items brought from home. There is a limit to (1) item that can be washed in a regular-sized washer. No over-sized blankets or beds permitted. Item must be presented in a bag upon arrival. Any toys or treats must be washable or presented in an new, sealed package.

Please list and describe all items you will be bringing with your pet:

I understand Animal Clinic of Chardon is not responsible for lost or damaged toys, bedding, or other items left with my pet. By clicking Yes, you have read the above & are in full agreement. *

Yes, I Agree

I would like my pet to receive additional 15 minute interactive play sessions each day ($10/session) *

Yes No

I would like my pet to receive a Kong filled with goodies (cats and dogs only - $2/time) *

Yes No

I would like my pet to have a bath the day before check-out ($18) *

Yes No

I would like my pet to have a nail trim ($8-15) *

Yes No

Please list any other services or procedures such as lab work, exam and vaccines, etc.

Medical Illness Policy

One of the advantages of boarding your pet at Animal Clinic of Chardon is that veterinary attention is readily available should the need arise. If your pet becomes ill, we will always attempt to call the emergency number(s) listed regarding your pet’s symptoms, treatment options, and estimate of additional costs. If no one can be reached, we at the Animal Clinic of Chardon will perform whatever services the doctor deems necessary for the best care for your pet until someone can be reached. This includes only non-elective treatments, any necessary diagnostics and emergency procedures. If you do not provide consent by initialing below, we will not be able to provide your pet with medical attention should he/she require it. We also assure you we will only do what is necessary until you are reached.

Please select one of the following (READ CAREFULLY): *

Animal Clinic of Chardon may provide necessary veterinary care for any illness or injury that may occur during my pet’s stay until I can be reached. I agree to pay for such medical charges in accordance with the above policy Animal Clinic of Chardon may not provide necessary veterinary care for any illness or injury that may occur during my pet’s stay. I understand that by choosing this option, I am denying my pet immediate, potentially life-saving treatment.

Animal Clinic of Chardon Boarding Release & Understanding:

Pets must be picked up during normal office hours and when agreed upon at scheduling. We are unable to discharge after hours or when the hospital is closed.
Summer and Holiday boarding rates apply to specified dates, please ask a client service representative for more information. These rates are in addition to the base rate for all cage options.
Animal Clinic of Chardon cannot guarantee the health of any animal, but pledges to provide appropriate care to all boarders.I agree to hold the hospital harmless for conditions that are unavoidable in boarding environments such as, but not limited to, weight loss, rough hair coat, kennel cough, upper respiratory infection, fleas and diarrhea.
My pet is in good health and has not, to my knowledge, been exposed to any contagious or communicable illnesses within the last 14 days. I have not noted any vomiting, diarrhea, coughing or sneezing. Note: some medical problems may not be evident in a boarding environment.
I understand that if I fail to pick up my pet within 12 days of the scheduled pickup, he/she will be considered "abandoned" and will be handled in accordance with state law, and that doing so does not relieve me of my financial obligations.
I hereby represent that all information provided in this document is accurate and up-to-date and agree to pay (at check-out) for all services I have requested. Note: a deposit may be required on admission at the discretion of the hospital.
We require you to notify us 24 hours prior to your pet's check-in day in the event you must cancel your boarding reservation. If you fail to notify us about your cancellation and do not show for your reservation you will be charged a fee equal to (1) night of stay per every (3) days reserved.

By signing here, I agree that I've read and understand the above and am in full agreement. *

Clear

Animal Clinic of Chardon has my permission & the right to take photographs of my pet, and to copyright, use and publish the same in print and/or electronically. *

Yes, I agree No, I do not agree

Boarding Admission Form & Consent

Diet & Feeding Information

Medical Information & Medications

Behavior & Playtime

Belongings

We provide items such as toys, beds, blankets, food bowls. If you bring any of your pet's belongings from home, you do so at your own risk. We will make every effort to assure they are not misplaced but can not make guarantees.

Additional Services

Medical Illness Policy & Boarding Release