Medical Boarding Patient Registration
Boarding Details
Client Full Name
*
First Name
Last Name
Patient Name
*
Patient Breed:
*
Arrival Date:
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Departure Date:
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Contact Information
PRIMARY Phone Number where you can be reached:
*
Please enter a valid phone number.
SECONDARY Phone Number where you can be reached:
Please enter a valid phone number.
EMERGENCY CONTACT in the event that we are not able to reach you by phone:
*
Please enter a valid phone number.
EMERGENCY CONTACT Name
*
First Name
Last Name
Personal Items
We prefer that you do not send personal items such as toys or bedding with your pet. If these items become soiled and need to be washed, they will be washed with our general hospital laundry. We do several hundred pounds of laundry each day and it is very difficult to keep track of individual personal items. If you must bring personal items, please make sure that each item is labeled in permanent marker with your pet's name. Please bring a list of personal items with you.
I understand and agree that MCAH is not responsible for lost or damaged items.
*
YES
Flea & Tick Preventative
MCAH requires that all boarding patients be protected against external parasites and currently taking an effective flea & tick preventative. MCAH recommends Bravecto for all dogs (Bravecto Monthly for dogs under 6 months of age and Bravecto 12-week for dogs 6 months and older), and Bravecto Plus for all cats 6 months and older (8 weeks of protection).
I understand and agree that my pet must have received flea & tick preventative prior to boarding at MCAH.
*
YES
Name of flea & tick preventative that your pet is currently using:
*
Date flea & tick preventative last administered or will be administered prior to boarding arrival:
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Veterinary Services
Please indicate additional veterinary services you would like performed while your pet is with us
Administer any vaccines due within next 30 days (doctor exam may be required)
Toenail Trim
Suture Removal
Heartworm/Tick Screening Test
Recommended Lab work
Fecal Screening
Other
Excessive Barking - due to local ordinances, MCAH monitors and manages excessive barking.
*
N/A Cat Boarding
I DO authorize mild sedatives to be administered at the discretion of the treating veterinarian.
I DO authorize the use of a Bark Collar as needed for excessive barking.
I DO NOT authorize the use of a Bark Collar for excessive barking.
Feeding
What will we be feeding your pet while boarding?
*
Please Select
Please feed MCAH Diet (Purina EN)
I will provide my own food (please specify)
Name of food provided
How much food do you feed your pet each day?
*
Dry food
Wet food
AM
PM
Medical Care
Please provide clear instructions for the medical care of your pet while boarding with us.
Medications - please list all medications that need to be administered to your pet while boarding
Medication name and Strength
How much?
How often?
1
2
3
4
5
Notes regarding medical care
Medical Treatment Authorization
All boarding patients are carefully monitored throughout their stay with us. If we observe any minor conditions which we feel may require medical evaluation and treatment (such as GI upset, mild skin irritations), please advise how you would like us to proceed:
*
Please call me to authorize any treatments that would incur additional costs.
Treat as the Veterinarian feels necessary. I understand that additional charges may be incurred.
I pre-authorize additional medical treatment charges not to exceed the following amount:
Diabetic Patients
In the event that your pet does not eat regular meals, we will check your pet's blood glucose level prior to administering insulin. Additional charges per BG check are as follows: $10 with owner-provided supplies, $16 with MCAH-provided supplies.
I agree to pay all charges incurred in full upon discharge of my pet.
*
Yes
Signature
*
Clear
Submit
Should be Empty: