Jacksonville Veterinary Hospital Canine Boarding Consent Form

Last Name*

This person must be legally and finanacially responsible to make medical decisions for the pet listed on this form.

Owner First Name*

This person must be legally and financially responsible to make medical and decisions for the pet listed on this form.

Pet's Name*

Breed*

Sex*

Color/Description*

Your pet's current weight*

*During peak season runs are reserved for dogs over 40 pounds (Memorial Day through Labor day, Thanksgiving, Christmas and New Years) We cannot guarantee a small dog in a large enclosure unless there is space available, however your pet will receive the same quality of activity and enrichment regardless of enclosure size

ARRIVAL DATE Date PICK UP DATE Date

PICK UP/DROP OFF HOURS:

9AM-12PM OR 5PM-7PM

NOTE: If you arrive outside of these hours our staff are busy caring for animals and may not be available to check in/out. Please adhere to the posted hours. If you arrive outside of normal hours a fee may apply.

WE ARE NOT OPEN FOR PICKUP/DROP OFF ON MAJOR HOLIDAYS

Approximate arrival time: SEE ABOVE FOR AVAILABLE HOURS

Approximate pickup time: SEE ABOVE FOR AVAILABLE HOURS

Preferred Reserved Space*

All dogs receive the same amount of activity in the yard each day regardless of room reserved

Do you have more than one pet staying with us?*

YesNo

If you have more than one dog boarding with us, would you like them to board together in the same space?*

Yes, board my pets togetherNo, board my pets in separate spaces

Is your pet on a monthly heartworm preventative, and if so what kind?

Example: Interceptor Plus, Heartgard, etc.

Is your pet on a monthly flea and tick preventative, and if so what kind?

Example: Credelio, Frontline Gold, etc.

Has your pet ever had seizures?*

NoYes

Does your pet have diabetes?*

NoYes

Does your pet have a history of any other types of medical conditions or health concerns? PLEASE CALL TO DISCUSS MEDICAL CONCERNS UPON SUBMITTING THIS FORM*

YesNo

Describe any medical conditions here:*

Will you need us to give your pet medications while staying with us?*

Yes , please give my pet medications while they are boarding. I understand and agree to pay the additional charge per day for the animal care staff to administer my pet's medication. This fee ensures the pet receives each dose of medication properly regardless of how it is administered. *A different fee applies for insulin.No, my pet does not require any medications while boarding.

IMPORTANT: WE KNOW SOMETIMES THE DOSE CHANGES ON YOUR PET'S MEDICATION(S) ACCORDING THE THE DOCTOR'S INSTRUCTIONS. IN THIS INSTANCE, THE DRUG LABEL MAY BE DIFFERENT THAN WHAT YOU WERE INSTRUCTED TO GIVE.

PLEASE WRITE THE INSTRUCTIONS FOR ALL MEDICATIONS EXACTLY AS YOU ***CURRENTLY*** GIVE THEM AT HOME.

ALL MEDICATIONS MUST BE PROVIDED IN THE ORIGINAL PRESCRIPTION CONTAINER FROM THE VET/ PHARMACY WITH THE DRUG LABEL ON IT (NO BAGGIES/PILL BOXES).

Medication name, dose and frequency

Example: Amoxicillin 250mg Give one pill by mouth every 12 hours.

When was the last dose given?

Date and time, which meds were given?

Medication name, dose and frequency

Example: Amoxicillin 250mg Give one pill by mouth every 12 hours.

When was the last dose given?

Date and time, which meds were given?

Medication name, dose and frequency

Example: Amoxicillin 250mg Give one pill by mouth every 12 hours.

When was the last dose given?

Date and time, which meds were given?

Medication name, dose and frequency

Example: Amoxicillin 250mg Give one pill by mouth every 12 hours.

When was the last dose given?

Date and time, which meds were given?

Does your pet have any behavioral tendancies or concerns?*

Has your pet ever bitten someone, showed signs of aggression or any behavioral issues we need to be aware of? PLEASE CALL 410-666-4405 TO DISCUSS BEFORE PROCEEDING WITH RESERVATION.*

NoYes

Does your pet have a history of eating beds/blankets/toys/foreign objects?*

We provide all bedding and toys at no extra charge. Please note that if you choose to bring your own belongings we are not responsible for damaged or destroyed items. We are not responsible for your personal pet belongings (blankets, toys, etc.) being injested while boarding.

Please list any other notes you wish for our staff to know about your pet or their care.

NOTE: If your pet becomes dirty during their stay, we may/may not bathe them, as our schedule/staffing allows. If we do bathe your pet due to hygeine concern a fee will apply. If multiple baths are needed we reserve the right to charge as applicable.

Describe any personal belongings. Be as specific as possible.

We provide your pet with clean bedding, blankets, and toys at no additional charge and do not recommend bringing your own items as they could be damaged or destroyed. Jacksonville Vet Boarding is not liable for any damaged or lost items while boarding including collars, leashes, harnesses, bankets, beds, toys, etc.

Would you like your pet to eat our kennel's provided food (Purina EN for gastrointestinal support) OR did you bring your own food? (*please provide extra food in case of emergency)*

Please feed Purina ENPlease use my own food that I provided

Does your pet have any food allergies?*

Yes (*WE WILL NOT FEED ANY OTHER FOOD ITEMS OTHER THAN WHAT YOU HAVE PROVIDED)No (there is a chance we may feed treats or our own diet)

How much food do you feed per meal?*

example: 1 cup

How often do you feed:*

Once per dayTwice per dayThree times per dayFree feed- leave food down all day

Can we feed your dog treats?

Yes, I authorize the staff to give treats during my pet's stay.No, please DO NOT feed my dog treats.

Do you come to Jacksonville Vet for medical services?

Yes, my pet is a current patient at Jacksonville Vet.No, my pet(s) go elsewhere for veterinary services.

We require your pet's COMPLETE medical history on file while they board (in case of medical emergency). Please upload copies of your pet's complete medical records here:

If you are not able to upload please have your regular vet office send files to JACKSONVILLEVETBOARDING@GMAIL.COM or drop the paperwork off to our front desk before the day of your reservation. WE RESESRVE THE RIGHT TO CANCEL YOUR PET'S RESERVATION IF WE DO NOT RECEIVE YOUR PET'S MEDICAL HISTORY.

I confirm that my pet is up to date on all required vaccinations for boarding, including rabies, distemper, bordetella and influenza. If my pet is not up to date, I authorize Jacksonville Veterinary Hospital to complete an examination and all required vaccines for an additional cost and assume financial responsibility for such services.*

Are there any medical concerns you have, or treatments you wish for the Doctor to provide? Be specific. YOU MUST CALL TO SCHEDULE THIS IN ADVANCE 410-666-1390.

By filling out this section you give consent for the staff to treat your pet and assume all responsibility for such services.

If fleas or ticks or intestinal parasites are found while your pet is boarding, we reserve the right to treat them while here. I authorize Jacksonville Vet to examine my pet and administer a flea/tick/intestinal parasite treatment if any parasites are found while boarding.*

Would you like us to bathe your pet before you pick up? THIS MUST BE SCHEDULED FOR A SPECIFIC DAY/TIME WITH THE STAFF SO YOUR PET IS CLEAN/READY AT THE TIME OF PICKUP. (*additional fee applies, baths are priced by weight of pet)

Yes, please bathe my pet for an additional fee.No thank you, do not bathe my pet.

Please indicate any additional services you wish to have completed while boarding for an additional charge:

Nail trimAnal gland expressionBasic ear cleaning (non-medical)

NOTE: If your pet becomes dirty or unsanitary during his/her stay, we reserve the right to bathe your pet as deemed necessary for an additional fee (based on weight). We cannot guarantee your pet will be bathed/completed by the time you pick up unless a time is discussed in advance with a staff member.

Will you be out of the country?*

YesNo

May we take/share photos of your pet on social media or our website, etc.?

YesNo

PLEASE INDICATE A PERSON WHO WILL BE MEDICALLY AND FINANCIALLY RESPONSIBLE FOR THIS ANIMAL IF YOU ARE UNAVAILABLE, AND THEIR PHONE NUMBER(S).*

LAST NAME, FIRST NAME, PHONE NUMBER(S)

READ CAREFULLY: In signing below, I acknowledge that I am the owner of the animal listed on this document, and am authorized to make health related and financial decisions for this animal. If my pet needs a bath due to sanitary reasons during its stay, I authorize the staff to bathe my pet and agree to pay for this service at the current prices. I understand that Jacksonville Vet is not liable for any lost or damaged personal belongings. I understand that putting my animal in a population of other animals puts them at risk for potential contagious disease. Jacksonville Vet cannot guarantee your pet will not be exposed to potential contagious disease such as kennel cough or a virus. If my pet shows any signs of contagious disease or fleas present while boarding, I understand that my pet may be isolated and I authorize Jacksonville Vet to treat my pet as deemed appropriate by a Veterinarian. I understand it is possible I may be called to come pick up my pet if signs of contagious disease are found. If a medical problem arises while boarding or during an examination, our Veterinarian may recommend treatment and additional testing. If I am unavailable and my pet needs medical attention, I admit my pet to Jacksonville Veterinary Hospital and its associates for care, IF IT IS A POSSIBILITY. WE DO NOT OFFER 24 HOUR CARE. Jacksonville boarding staff are not medically trained and do NOT provide overnight care, nor are the boarding pets under 24 hour supervision. In the event of a medical emergency, the boarding staff may alert the medical staff (during normal operating hours is they are available) and follow their instructions. In the event of a medical emergency, If I am unavailable, I authorize Jacksonville Veterinary Hospital staff to treat or not treat my pet by any means necessary until contact is made. I authorize the transportation to a local emergency care facility for emergency treatment or overnight care if recommended. I have carefully read and agreed to all terms listed on this form and hereby release Jacksonville Veterinary Hospital Inc, its Doctors and its staff from any and all liability arising out of my pet's stay and any service that is provided*

TODAY'S DATE*

PRIMARY CONTACT NAME*

this is the legal owner and authorized person to make medical and financial decisions for this animal

PRIMARY CONTACT PHONE NUMBER*

SECONDARY CONTACT*

In the event that the primary contact is unavailable, the secondary contact is authorized to make medical and financial decisions for this animal. If no contact can be made, our Doctors are authorized to use their judgement and react accordingly in the best interest of the animal including emergency treatment. In extreme cases, humane euthanasia may be considered, only if absolutely necessary. The owner of this animal agrees to hold Jacksonville Veterinary Hospital and all associates free of any and all liability arising from such an emergency. Furthermore, the owner agrees to take financial reponsibility for such services.

SECONDARY CONTACT PHONE NUMBER*