Boarding Agreement
Today's Date
*
-
Month
-
Day
Year
Date
Owner's Name
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Are you currently experiencing any symptoms that could be related to the COVID-19 virus? We ask that if you are feeling ill that you do not bring your pet into the hospital and instead have a friend or family member bring your pet in. We are able to accommodate curbside service if you would like just please select that option below.
*
I am not experiencing any symptoms
I am currently experiencing symptoms
I am not experiencing any symptoms but would like curbside service
Pets Name (List all that are boarding)
*
Admission Date
*
-
Month
-
Day
Year
Date
Discharge Date
*
-
Month
-
Day
Year
Date
Emergency Contact Name (If different from owner's name)
*
First Name
Last Name
Emergency Phone Number
*
-
Area Code
Phone Number
All animals admitted must be current on vaccinations and free from internal and external parasites. Any animal found to have parasites will be treated at the owners expense.
*
(Please initial stating that you understand)
There is an additional charge for dropping off or picking up pet while hospital is closed. Must be arranged beforehand and prepaid. Drop off and pick up times are at 8 AM OR 5PM ONLY. The charge for picking up when closed is $25. NO HOLIDAY DROP OFF OR PICK UP.
*
(Please initial stating you understand)
There are additional charges for administering medications to your pet while in our care. Medication Level 1 - Additional $7 per day (Once daily administration - up to 3 medications) Medication Level 2 - Additional $12 per day (Twice daily administration - up to 3 medications) Medication Level 3 - Additional $17 per day (Administration more than twice daily and/or more than 3 different medications) *All medications brought in for boarding must be in original containers*
*
(Please initial stating you understand)
Will your pet require medications while boarding with us? If so please list medications below with their instructions.
*
Does your pet need medical treatments while boarding? Exam, vaccines, etc.
*
Does your pet need any of the following services while boarding?
Grooming
Bathing
Nail Trim
Anal Gland Expression
The clinic is not responsible for any lost/damaged personal belongings left with your pet. We will do our best to not send home soiled belongings but based on timing/pick up it may happen. Please understand that there is a possibility that bedding/blankets could be returned to owners soiled. Please describe all belongings you plan on leaving with your pet.
*
Please label all belongings!
What are your pets feeding instructions?
*
Own food/kennel dry food, how much, how often?
Has your pet had any coughing or sneezing? (Signs of an upper respiratory infection?)
*
Is there anything else you would like us to know about your pet while they are boarding?
I fully intend to pick up my pet on or around the above date specified. If circumstances arise which require a change in dates, I will notify the veterinary hospital of a new pick up date. Reasonable precautions will be used against injury or death of your pet while boarding. Martin Downs Animal Hospital and staff will not be held liable for problems that my develop during your pet's stay provided reasonable care and precautions are followed. I understand that any problems that may develop with my pet while boarding will be treated as deemed best by the staff and veterinarians. I assume full responsibility for all expenses incurred. All costs shall be paid on release of the pet for boarding and all other treatment necessary.
*
(Please initial stating that you understand)
Signature of Owner/Agent
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: