Chico AH - Boarding Form

1
BOARDING REQUIREMENTS

Dogs

Exam: Current Annual Health Exam (AHE) with a DVM at Chico Animal Hospital. This is so a DVM can have an established relationship with you and your pet to ensure they are healthy enough for boarding. They can also determine if boarding is a safe option for your pet.

Vaccines: Bordetella, Rabies, DAPP

List of items you can bring: food (dry or wet, please no raw diets), treats (such as milk bones), collars/ID

List of items not to bring: bedding (we provide this), bowls (unless your pet requires a slow feeder, we can provide these), toys (there is a chance these may be lost, damaged or your pet may eat them!), clothing (there is a chance these may be lost, damaged or your pet may eat them!), leashes (we have slip leads for in-hospital use, your leash may be lost)

Dogs are required to be on heartworm prevention and internal flea/tick prevention. Some animals being treated in our clinic do have fleas and this is to help protect our boarding animals.

Cats

Exam: Current Annual Health Exam (AHE) with a DVM at Chico Animal Hospital. This is so a DVM can have an established relationship with you and your pet to ensure they are healthy enough for boarding. They can also determine if boarding is a safe option for your pet.

Vaccines: FVRCP, Rabies

List of items you can bring: food (dry or wet, please no raw diets), treats, collars/ID

List of items not to bring: bedding (we provide this), bowls (unless your pet requires a slow feeder, we can provide these), toys (there is a chance these may be lost, damaged or your pet may eat them!), clothing (there is a chance these may be lost, damaged or your pet may eat them!), leashes (we have slip leads for in-hospital use, your leash may be lost)

Cats are required to be on internal flea/tick prevention. Some animals being treated in our clinic do have fleas and this is to help protect our boarding animals.
2
Primary Owner Information
First Name
Last Name
Phone number
Email
3
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
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
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
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Is there a Co-Owner?
Yes
No
5
Co-Owner Information
First Name
Last Name
Phone number
Email
6
Admission date and time: Between 9:00 AM & 5:00 PMPlease enter the admission date of your pre-scheduled reservation. This does not reserve your pet’s stay, if you have not already scheduled your pet’s reservation, please give us a call at (530) 342-0518.
Date
Year
Month
Day
9
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
00
30
Minutes
AM
AM
PM
7
Discharge date and time: Between 9:00 AM & 5:00 PM
Date
Year
Month
Day
9
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
00
30
Minutes
AM
AM
PM
8
Pet’s Name* This field is required.You will be given the option to add additional pets after completing the information for pet one.
9
Animals staying at Chico Animal Hospital will be offered a natural commercially available dry and/or wet diet in an amount appropriate for their breed, activity level, age, and your recommendations. We are able to offer a service at an additional fee to feed special foods that you bring for their stay. Are you bringing your pet’s food?
Yes
No
10
Owner provided special food will incur a daily fee of $5.25/day. Raw foods present a health risk to staff and other animals and as such will be replaced with a natural commercially available dry and/or wet food during boarding.
11
Please list your pet’s feeding instructions. * This field is required.(E.G. free-feed, 1 cup twice a day…)
12
Does your pet need medication?
Yes
No
13
Please list your pet's medications, dosing, and frequencyThere is a daily fee of $5.25 for administering medications.
14
Would you like our kennel staff to administer Capstar on the last day of your pet's stay with us?All boarding animals are required to be on external parasite control and dogs are required to be on internal parasite control. You will be asked to upload proof (receipts for products) if we don’t have record of it in our medical records. Animals showing signs of parasites will be tested and treated to ensure that the hospital stays free of parasites. The cost for this will be added to your final bill. If you want to be extra sure that no fleas come home with your pet, we can treat your animal with Capstar, a short acting flea adulteration that is safe to use with other long acting medication.
Yes
No
15
Do we have record of your pet’s current parasite control medication on file?
Yes
No
16
What type of Parasite Control medication is your pet currently on?
17
Please enter the date of the last dose given
Date
Year
Month
Day
18
Please upload your proof (receipts for products) of parasite control
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
19
Are there other things that you would like done while your pet is staying with us?Prices vary for additional services.
Nail Trim
Anal Gland Expression
Clean Ears
Refill Medication
Other
Nothing
20
Please list the medications that you would like us to refill.
21
Please list any additional requests here.
22
Do you have any other pet’s that will be boarding with us during this visit?
Yes
No
23
Pet’s Name* This field is required.You will be given the option to add additional pets after completing the information for pet two.
24
Animals staying at Chico Animal Hospital will be offered a natural commercially available dry and/or wet diet in an amount appropriate for their breed, activity level, age, and your recommendations. We are able to offer a service at an additional fee to feed special foods that you bring for their stay. Are you bringing your pet’s food?
Yes
No
25
Owner provided special food will incur a daily fee of $5.25/day. Raw foods present a health risk to staff and other animals and as such will be replaced with a natural commercially available dry and/or wet food during boarding.
26
Please list your pet’s feeding instructions. * This field is required.(E.G. free-feed, 1 cup twice a day…)
27
Does your pet need medication?
Yes
No
28
Please list your pet's medications, dosing, and frequencyThere is a daily fee of $5.25 for administering medications.
29
Would you like our kennel staff to administer Capstar on the last day of your pet's stay with us?All boarding animals are required to be on external parasite control and dogs are required to be on internal parasite control. You will be asked to upload proof (receipts for products) if we don’t have record of it in our medical records. Animals showing signs of parasites will be tested and treated to ensure that the hospital stays free of parasites. The cost for this will be added to your final bill. If you want to be extra sure that no fleas come home with your pet, we can treat your animal with Capstar, a short acting flea adulticide that is safe to use with other long acting medication.
Yes
No
30
Do we have record of your pet’s current parasite control medication on file?
Yes
No
31
What type of Parasite Control medication is your pet currently on?
32
Please enter the date of the last dose given
Date
Year
Month
Day
33
Please upload your proof (receipts for products) of parasite control
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
34
Are there other things that you would like done while your pet is staying with us?Prices vary for additional services.
Nail Trim
Anal Gland Expression
Clean Ears
Refill Medication
Other
Nothing
35
Please list the medications that you would like us to refill.
36
Please list any additional requests here.
37
Do you have any other pet’s that will be boarding with us during this visit?
Yes
No
38
Pet’s Name* This field is required.You will be given the option to add additional pets after completing the information for pet three.
39
Animals staying at Chico Animal Hospital will be offered a natural commercially available dry and/or wet diet in an amount appropriate for their breed, activity level, age, and your recommendations. We are able to offer a service at an additional fee to feed special foods that you bring for their stay. Are you bringing your pet’s food?
Yes
No
40
Owner provided special food will incur a daily fee of $5.25/day. Raw foods present a health risk to staff and other animals and as such will be replaced with a natural commercially available dry and/or wet food during boarding.
41
Please list your pet’s feeding instructions. * This field is required.(E.G. free-feed, 1 cup twice a day…)
42
Does your pet need medication?
Yes
No
43
Please list your pet's medications, dosing, and frequencyThere is a daily fee of $5.25 for administering medications.
44
Would you like our kennel staff to administer Capstar on the last day of your pet's stay with us?All boarding animals are required to be on external parasite control and dogs are required to be on internal parasite control. You will be asked to upload proof (receipts for products) if we don’t have record of it in our medical records. Animals showing signs of parasites will be tested and treated to ensure that the hospital stays free of parasites. The cost for this will be added to your final bill. If you want to be extra sure that no fleas come home with your pet, we can treat your animal with Capstar, a short acting flea adulticide that is safe to use with other long acting medication.
Yes
No
45
Do we have record of your pet’s current parasite control medication on file?
Yes
No
46
What type of Parasite Control medication is your pet currently on?
47
Please enter the date of the last dose given
Date
Year
Month
Day
48
Please upload your proof (receipts for products) of parasite control
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
49
Are there other things that you would like done while your pet is staying with us?Prices vary for additional services.
Nail Trim
Anal Gland Expression
Clean Ears
Refill Medication
Other
Nothing
50
Please list the medications that you would like us to refill.
51
Please list any additional requests here.
52
Do you have any other pet’s that will be boarding with us during this visit?
Yes
No
53
Pet’s Name* This field is required.
54
Animals staying at Chico Animal Hospital will be offered a natural commercially available dry and/or wet diet in an amount appropriate for their breed, activity level, age, and your recommendations. We are able to offer a service at an additional fee to feed special foods that you bring for their stay. Are you bringing your pet’s food?
Yes
No
55
Owner provided special food will incur a daily fee of $5.25/day. Raw foods present a health risk to staff and other animals and as such will be replaced with a natural commercially available dry and/or wet food during boarding.
56
Please list your pet’s feeding instructions. * This field is required.(E.G. free-feed, 1 cup twice a day…)
57
Does your pet need medication?
Yes
No
58
Please list your pet's medications, dosing, and frequencyThere is a daily fee of $5.25 for administering medications.
59
Would you like our kennel staff to administer Capstar on the last day of your pet's stay with us?All boarding animals are required to be on external parasite control and dogs are required to be on internal parasite control. You will be asked to upload proof (receipts for products) if we don’t have record of it in our medical records. Animals showing signs of parasites will be tested and treated to ensure that the hospital stays free of parasites. The cost for this will be added to your final bill. If you want to be extra sure that no fleas come home with your pet, we can treat your animal with Capstar, a short acting flea adulticide that is safe to use with other long acting medication.
Yes
No
60
Do we have record of your pet’s current parasite control medication on file?
Yes
No
61
What type of Parasite Control medication is your pet currently on?
62
Please enter the date of the last dose given
Date
Year
Month
Day
63
Please upload your proof (receipts for products) of parasite control
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
64
Are there other things that you would like done while your pet is staying with us?Prices vary for additional services.
Nail Trim
Anal Gland Expression
Clean Ears
Refill Medication
Other
Nothing
65
Please list the medications that you would like us to refill.
66
Please list any additional requests here.
67
Please provide any additional emergency contact information to be contacted if we are unable to reach you.
68
Boarding Medical Release Plan

Thank you for boarding your pet(s) at Chico Animal Hospital. We will take great care of your pet(s). We would like you to know that animals are checked on a regular basis to ensure their wellness and safety, however there is no overnight supervision. Pets that do develop any injury, illness or other medical problems while in our care will be evaluated by our doctors and treated while we attempt to reach you or your emergency contact. Additional fees will be added to your account for these services.
69
Valley Oak Veterinary Center is the local emergency center. If your pet(s) needs urgent care that we cannot provide would you like us to transport your pet(s) here for continued care?
Yes
No
70
Life-threatening emergencies will be treated and stabilized while we attempt to contact you. Fees for these services, treatments, and medications will be added to your final bill and are due at the end of your pet's stay (this may involve surgery, anesthesia, intensive care, or transfer to a 24-hour care facility). If we are unable to stabilize your pet from a life-threatening emergency and our attempts to contact you or your emergency contact have failed, do we have your permission to perform humane euthanasia?
Yes
No
71
Would you like us to contact you prior to treating any non-life-threatening problems (such as simple diarrhea, minor wounds, hot spots, ear infections, etc.)?
Yes
No
72
Signature* This field is required.I, the undersigned owner and/or agent for the owner, acknowledge that I have been made fully aware of the risks of boarding, boarding requirements, and charges associated with my pet’s stay at Chico Animal Hospital. I have provided accurate information regarding my pet's health status, medications, and treatment wishes. I accept full financial and medical responsibility for my decision and I release Chico Animal Hospital and its staff of any wrong doing if my pet experiences any complications from boarding or medical care. I understand that Chico Animal Hospital is not responsible for any damaged or lost items.
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BOARDING REQUIREMENTS

Dogs

Cats

Boarding Medical Release Plan