Shaffer Animal Hospital - Boarding Check-In New

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Please complete all questions in as much detail as possible to help make your pet’s stay with us as close to home as possible
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Owner’s Name* This field is required.
Owner’s First Name
Owner’s Last Name
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
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Aruba
Australia
Austria
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The Bahamas
Bahrain
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Bolivia
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Burkina Faso
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Cape Verde
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Chad
Chile
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Cote d'Ivoire
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Djibouti
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Ethiopia
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Finland
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The Gambia
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Liberia
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Lithuania
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Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
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Solomon Islands
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Somaliland
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South Ossetia
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eSwatini
Sweden
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Syria
Taiwan
Tajikistan
Tanzania
Thailand
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Togo
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Tonga
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Vietnam
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Isle of Man
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Western Sahara
Yemen
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Zimbabwe
Other
Country
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Best phone number to reach you during your pet’s stay* This field is required.
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Email* This field is required.
example@example.com
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Emergency contact information if we cannot reach you during their stay* This field is required.
Emergency Contact Name
Emergency Contact Number
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Pet Information #1* This field is required.
Pet’s Name
MALE
FEMALE
Is your pet?
SPAYED
NEUTERED
INTACT
Is your pet? SPAYED/NEUTERED OR INTACT
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If your pet is an unspayed female, when was their last heat cycle?* This field is required.
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Add more pets* This field is required.
Yes
No
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Pet Information #2* This field is required.
Pet’s Name
MALE
FEMALE
Is your pet?
SPAYED
NEUTERED
INTACT
Is your pet? SPAYED/NEUTERED OR INTACT
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If your pet is an unspayed female, when was their last heat cycle?* This field is required.
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Add more pets* This field is required.
Yes
No
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Pet Information #3* This field is required.
Pet’s Name
MALE
FEMALE
Is your pet?
SPAYED
NEUTERED
INTACT
Is your pet? SPAYED/NEUTERED OR INTACT
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If your pet is an unspayed female, when was their last heat cycle?* This field is required.
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Add more pets* This field is required.
Yes
No
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Pet Information #4* This field is required.
Pet’s Name
MALE
FEMALE
Is your pet?
SPAYED
NEUTERED
INTACT
Is your pet? SPAYED/NEUTERED OR INTACT
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If your pet is an unspayed female, when was their last heat cycle?* This field is required.
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Start Date of Boarding Reservation* This field is required.
Date
Year
Month
Day
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End Date of Boarding reservation* This field is required.
Date
Year
Month
Day
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Will your pet be receiving additional playtimes?* This field is required.(Your pet will be allowed outside three times per day. You may add on additional playtimes with our animal care technicians for an additional fee. You may add up to two additional times during the week, 1 additional on weekends, and no additional time on holidays)
Yes
No
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If yes, please list which days you would like to add additional playtime* This field is required.SPECIFY DATES
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Is your pet diabetic or epileptic?* This field is required.
Yes
No
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If yes, please bring all medications and insulin. Please list in as much detail as possible, your pet’s daily treatment needs.* This field is required.
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Does your pet have any allergies we need to be made aware of?* This field is required.
Yes
No
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If yes, please describe in detail your pet’s allergy history* This field is required.
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Is your pet on flea or heartworm medication monthly?* This field is required.
Yes
No
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If yes, please list the name of the medication and the date of the last dose administered. * This field is required.
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Have you seen any fleas or ticks on your pet or in their environment?* This field is required.
Yes
No
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If yes, please indicate when and where?* This field is required.
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Has your pet had any coughing, sneezing, vomiting, or diarrhea recently?* This field is required.
Yes
No
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If yes, how long ago and how frequently did this occur?* This field is required.
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Has your pet traveled or attended a dog show recently?* This field is required.
Yes
No
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If yes, How long ago and where?* This field is required.
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Is your pet eating & drinking well at home?* This field is required.
Yes
No
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If no, please describe in as much detail what is going on?* This field is required.
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Will you be bringing their own food or will they be eating the kennel diet?* This field is required.
Bringing Food
Kennel Diet
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Feeding Instructions* This field is required.
What brand of dog food is your pet currently eating?
How much do you feed them daily?
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Will your pet have their first meal of the day when you drop them off?* This field is required.
Yes
No
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Does your pet receive medications or supplements that need to be administered by our technicians?* This field is required.
Yes
No
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If yes, please list all medication names, strength, directions, and quantity in as much detail as possible.* This field is required.
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Do you need and refills of your pet’s medication during their stay?* This field is required.
Yes
No
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If yes, please list name, strength, and quantity of medication* This field is required.
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Does your pet experience fear, anxiety, or stress when away from home or from you?* This field is required.
Yes
No
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If yes, would you like us to administer an all-natural anti-stress supplement called Zylkene to help make your pet’s stay as fear-free as possible?* This field is required.
Yes
No
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Would you like your pet bathed or groomed on the day of pick up?* This field is required.
Bath
Groomed
None
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If GROOM: Please upload a current side-profile photo of your pet so we can see the condition of their coat.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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If GROOM: Please list specific instructions for your pet’s groom* This field is required.Grooming services are subject to availability
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Is there anything we need to know to help comfort your pet during their stay?
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Shaffer Animal Hospital Boarding Policy

We appreciate the opportunity to board your pet for you. The doctors and staff will do their utmost to ensure the safetyand well being of your beloved ones while they are here.

1.To protect your pet from possible exposure to sick animals, the following vaccinations will be required and must be current for all pets boarding:

Cats - FVRCP and Rabies (FeLV is optional but recommended)
Dogs - Bordetella, DH(L)PP, Rabies, and Canine Influenza (H3N2) as of 9/11/2017.
All pets admitted to the hospital must have a negative fecal within the last year and be free of internal and externalparasites. Your pet will be treated on entry or discovery at your expense. if found with parasites.

2.Specific problems in your pet's health may arise due to the added stress and anxiety your pet may experience away from home. Such conditions include diarrhea, weight loss, loss of appetite, upper and lower respiratory disease, and will be treated at your expense. Diarrhea, i.e. stress colitis, is very common in a boarding environment. This primarily affects pets away from home who are nervous when separated from their owners. If your pet experiences diarrhea/inappetance, it will be treated at your expense, conservatively at first, with oral medications and special diet. If further treatment is required, i.e. fluid therapy, labwork, injections, etc. you will be notified as per your instructions under category 3 below. Though sanitation and disinfection are emphasized, respiratory disease such as tracheobronchitis may occur during or shortly after boarding in dogs. This will also be treated at your expense, usually with a short course of antibiotics and cough suppressants.
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In the event of illness other than above, Shaffer Animal Hospital will treat your pet at your expense, according to the following options. Please check one:* This field is required.
Please treat my pet as required, you don't have to call me.
Please inform me if costs exceed (enter amount on next slide)
Perform only conservative treatment; notify me for permission for further treatment
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Please specify the amount* This field is required.
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If no choice is indicated above, the first option shall apply.

Should a life-threatening or severe medical EMERGENCY(Where a lack of immediate intervention would be a detriment to patient's health) arise, I authorize the medical staff to treat my pet and/or perform such emergency procedures as may be necessary for the health of my pet until I can be notified, and will be responsible for all charges incurred.

4.You are welcome to leave toys and/or bedding with your pet; however we are not responsible for any items lost, damaged, or soiled. Animals will be fed Shaffer Animal Hospital's preferred kennel food (a bland diet from Hill's called Sensitive Stomach & Skin). However, if you wish to bring food for your pet, please make sure it has your pet's name and is in an amount of food appropriate to length of your pet's stay. It is not necessary to bring your pet's food of water containers. Owners of ferrets and other small mammals boarding should bring their own food, cage, and food/water container.

5.We ask that you call us if your pick-up date changes so that we can plan accordingly. If you neglect to pick up your pet within 10 days of the date scheduled, and we are not able to contact you within that time period, we will assume that your pet is abandoned and will handle your pet(s) as we see fit. This action does not relieve you from paying all costs of hospitalization and boarding services.

6.PLEASE NOTE, WHEN OUR FRONT OFFICE IS CLOSED (REGULAR BUSINESS HOURS), PETS WILL NOT BE DISCHARGED UNDER ANY CIRCUMSTANCES. (i.e. Saturdays after hours, Sundays, or holidays).

7. If your pet requires special handling, you are required to notify our front office staff before boarding your pet. Aggressive dogs, which cannot be handled safely by our staff, will not be allowed to board at Shaffer Animal Hospital for the safety and protection of our employees. Other medical conditions such as diabetes, require special treatment and expense while boarding, and need to be discussed before your pet stays with us.

8. Options while boarding:

Zylkene - Zylkene is a natural option to help your pet stay calm in challenging situations i.e, boarding, thunderstorms, and separation anxiety. It can be used short term prior to situations that trigger behavioral problems as well as long term. Zylkene contains a unique milk-derived protein with proven calming properties that is lactose-free. It keeps pets calm without drowsiness or sedation.We recommend beginning 1-2 days before boarding and continue through the boarding stay. We can give you the cost of this product upon request, as the dosage is based on your pet's weight and duration of stay.

Bathing/Grooming - We offer bathing and grooming at your request through GODOGS. For grooms, we recommend calling ahead of time to make the grooming appointment prior to coming in for boarding to ensure availability. Pets that are not being bathed at the owner's request will be available for discharge after 9:00 AM on the pick-up date specified by the owner. Pets being bathed at the owner's request will be available for discharge after 2:00 PM on the ownerspecified pick-up date.

Playtime - For dogs, we offer an additional 10 minutes outside to play freely and have one on one interaction in a safe enclosed environment for up to 2 times daily. Playtimes are in addition to the normal outside walk that is done three times a day. Please inform the receptionist at check-in if you are interested in this option. For cats, we also offer this option in which they are allowed to walk around the designated cat ward for 10 minutes, up to 2 times daily.
We will strive to make your pet's stay with us as safe and worry-free as possible, with an emphasis on maintaining their health and wellbeing.

I have read the above policy and authorize consent.
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Signature of the Owner/Authorized Agent* This field is required.Use your finger/mouse to sign below.
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