Jacksonville Veterinary Hospital Feline Boarding Consent Form

Last Name*

First Name*

Pet's Name*

Breed*

example: Domestic Short Hair

Sex*

FemaleFemale SpayedMaleMale Neutered

Description/Color*

describe your pet's appearance

ARRIVAL DATE Date PICKUP 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

Do you have more than one cat boarding with us?*

YesNo

Would you like your cats to board together in the same space, or separately. (*charges are per animal per night)*

Yes, board my cats togetherNo, board my cats separately

Will you provide your cat's food or would you like to use the provided food?*

I will bring my pet's own food (PLEASE BRING EXTRA IN CASE OF EMERGENCY)Please provide my pet with food while boarding

Please indicate how much food to feed and the frequency each day. Be specific.*

example: one cup of dry food plus 1/2 can of wet food twice per day

Does your pet have a history of aggression or biting people?*

NoYes (PLEASE CALL 410-666-4405 TO SPEAK TO SOMEONE BEFORE PROCEEDING WITH RESERVATION)

Does your pet have a history of eating foreign objects such as bedding or toys?*

NoYes

Does your cat have any history of seizures, cardiac problems, diabetes or chemotherapy?*

NoYes, my cat has one or more of these medical conditions. PLEASE CALL JACKSONVILLE VET TO DISCUSS BEFORE PROCEEDING 410-666-4405

Would you like us to give your pet medication while he/she is boarding?*

Yes, please give my pet their medications while boarding. I understand there is an additional charge for the staff to administer medications.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.

Medication name, dose and frequency*

Example: Amoxicillin 250mg. give one tablet by mouth every 12 hours.

When was the last dose given?

Medication name, dose and frequency

Example: Amoxicillin 250mg give one tablet by mouth every 12 hours.

When was the last dose given?

Medication name, dose and frequency

Example: Amoxicillin 250mg give one tablet my mouth every 12 hours.

When was the last dose given?

Medication Name, dose and frequency

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

When was the last dose given?

Provide any additional notes you wish for our staff to know about your pet or their care.

If fleas, ticks, intestinal parasites, or signs of contagious disease are found while my pet is in boarding, I authorize Jacksonville Veterinary Hospital to treat my pet as deemed appropriate by a veterinarian. *

Do you come to Jacksonville Vet for medical services?

Yes, my pet is a current patient at Jacksonville VetNo, my pet goes elsewhere for medical care

We require your pet's COMPLETE medical history (including all doctors notes- not just vaccines) on file in order to board (in case of emergency). Please obtain and upload a copy of your pet's medical history here:

I understand that proof of the rabies and FVRCP and any medical notes from your regular veterinarian are required for boarding. If my cat is not current on the required vaccines, I authorize Jacksonville Veterinary Hospital to administer the vaccines and examine my pet, and assume all financial responsibility for associated charges. *

If there is a serious medical condition while my pet is boarding, and I am unavailable:*

I authorize Jacksonville Veterinary Doctors and staff to treat my pet as necessaryDO NOT TREAT MY PET UNTIL CONTACT IS MADE

Will you be out of the country?*

NoYes, I will be out of the country

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

YesNo

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*

PRINT first name, last name

Primary Contact PHONE NUMBER*

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 AND PHONE NUMBER(S)

Secondary Contact Name*

PRINT first name, last. In the event that the primary contact is unavailable, the secondary contact is authorized to make medical 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 responsibility for such services.

Secondary Contact PHONE NUMBER*