Boarding consent

Magrane Pet Medical Center Boarding Guest Registration

Name *

First Name Last Name

Pet's Name *

Drop-Off Date: *

Date

Pick-Up Date: *

Date

While my pet is in boarding, I can be reached at this phone number:

Phone Number *

Please enter a valid phone number.

Alternate Phone number *

In case of emergency, these people are authorized to make decisions on my behalf:

Name

First Name Last Name

Phone Number

Please enter a valid phone number.

*Please advise your emergency contact that they are responsible for making medical decisions for your pet if we cannot reach you.

Feeding Instructions: Please list the amount and how often you feed your pet. *

Last time fed *

AAHA standards require that prescriptions brought in to be given to pets while boarding must be in their original labeled containers. Otherwise, MPMC will fill the prescription for the duration of the pet's stay, and the owner will be charged accordingly.

For any medications administered while boarding there is a $3.15 charge per dose given.

For any controlled substance medications administred while boarding there is a $9.26 charge per dose given.

Medication Instructions: Please list name of medication, times given, last time administered and when next dose is due. *

Charges begin the day you drop off your pet. Pets that go home BEFORE 12:00 PM will not be charged a boarding fee for that day; there are no pickups or drop offs between 12 and 2pm on weekdays or on Sundays. We do also ask that you pickup or drop off before 5pm. Magrane staff is here to care for your pet during regular operating hours Monday through Saturday. Dogs are let out 3 times a day Monday through Saturday. On Sundays an assistant will visit your pet twice a day to feed, water, medicate pets, and let dogs out for excercise.

I have read and understand the above paragraph *

Yes No (if no please call us)

Off leash okay in the fenced in backyard? (dog's only!)

I request the following additional services while my pet is being boarded at MPMC: Charges for services will apply

Update Vaccinations Bloodwork Urinalyses Fecal Nails Trimmed Ear Cleaning Anal Glands Expressed

MPMC requires that all boarded cats and dogs be current on vaccinations and be free of parasites (fleas, ticks, worms, protozoa such as giardia and coccidia) Dogs and cats not healthy enough for vaccination need yearly titers (blood tests) to determine that they are protected against contagious disease. Pets that were not vaccinated and tested for intestinal parasites at MPMC need a printed record of vaccinations and fecal analysis from their regular veterinarian. If necessary, dogs and cats will be updated on vaccinations or titers, fecal analysis, and treated for fleas and ticks at an additional fee.

Magrane Pet Medical Center's (MPMC) boarding facility is primarily a hospital, for pets that need medical care while their owners are away. For that reason, your pet will receive a complete Physical Examination on the day of admission for boarding.

Pets not examined at MPMC within the past 12 months will be examined by a Veterinarian and the appropriate fee will be charged.
Pets over the age of 7 that are due for the 6 month Senior Exam will be given a Senior Exam and appropriate fee will be charged.
Pets examined within the above recommended time frames will receive a complimentary exam from a Registered Veterinary Nurse, who will refer any health issues found to a veterinarian.

I have read the above and authorize the specified physical examination. If needed, I authorize my pet to be vaccinated, tested for parasites, and treated. If my pet needs emergency treatment, diagnosis, or surgery while boarding, I understand that a reasonable attempt will be made to contact me. If I cannot be reached, I agree to pay for any required emergency measures taken.

We have to ask this of all pets that are left in our care. In the event of a cardiac or respiratory arrest, do you want us to begin CPR while we try to contact you? *

Yes - I wish the staff of the Magrane Pet Medical Center to perform CPR (Resuscitation) on my pet if my pet suffers respiratory or cardiac arrest. I understand that my pet may not respond to CPR or may respond initially and then suffer another arrest later. I understand that my pet may die despite CPR. I understand that if my pet survives because of CPR, he/she may have brain damage. I agree to pay the fees associated with performing CPR. No - I DO NOT want CPR performed on my pet. I understand that if my pet stops breathing and/or his/her heart stops beating that my pet will die unless CPR is performed. I elect to have DNR (Do Not Resuscitate) orders placed on my pet’s record.

By signing below, I certify that I own or am the agent for the owner of the above described animal and do hereby consent and authorize Magrane Pet Medical Center, and its staff to hospitalize my pet, and to administer vaccinations, medications, tests. procedures, anesthetics, or treatments that the doctors deem necessary for the health, safety, or well-being of the animal while it is under their care and supervision.

By signing I agree to all of the above.

Owner Signature *

Clear