mandarinanimalhospital@gmail.com

Please indicate if you are a new or existing client:

New ClientExisting Client

Owner’s/Authorized Agent’s Name:

First NameLast Name

Today's Date"

Date

Date of Pickup:

Date

Time in:

Hour Minutes

AM/PM Option

Time Out:

Hour Minutes

AM/PM Option

Pet's Name:

Breed:

Sex:

MaleNeutered MaleFemaleSpayed Female

Person(s) to Contact in Case of Emergency:

Emergency Contact Phone Number(s):

Pet’s Belongings (carrier, toys, blankets, leash, etc.):

Special Instructions: (include detailed medication directions and anything you wish us to know):

Would you like your pet(s) to have a bath /groom?

BathGroomNo

It is our hospital policy that all pets are clean at the time of discharge. If your pet will be with us for an extended stay (four days or longer), he/she will likely need a clean-up bath before leaving. If a bath is necessary, it will be done on the day of discharge, and you will be charged at regular bath rates.

FOR YOUR PET’S HEALTH:

To ensure the protection of all pets under our care, the following immunizations must be up to date and given by a licensed veterinarian:

DOGS: DA2PP (Distemper/Parvo), Rabies, Bordetella (Kennel Cough)

CATS: FVRCP (Distemper), Rabies

Proof of vaccinations must be on file at the time of boarding or they will be administered upon admission.

I give my permission for the Mandarin Animal Hospital to update my pet’s immunizations in accordance with the above policy.

All boarders must be free of all internal and external parasites. This requires all pets to have a negative fecal result and heartworm test result on file. If parasites are found during boarding, Mandarin Animal Hospital reserves the right to treat at the owner’s expense.

I understand that no staff member is present overnight.

Medications

If your pet will be receiving medication during his or her stay, it must be in the original veterinary-labeled container with instructions for administration and your veterinarian’s phone number. Fees for medications that need to be filled or refilled during the time your pet is boarded will be added to your bill.

Type a question

	Dose	When is it due next?	Provided by owner? (yes / no)
Medication 1
Medication 2
Medication 3
Medication 4

Statement of Kennel Policy

1. Personal items may be left at your own risk. We are not responsible for loss or damage. Please clearly mark all belongings.

2. This facility cannot guarantee the health of any animal, but pledges to provide appropriate care to all boarders. I agree to hold this facility harmless for conditions that often are unavoidable in boarding environments, including, but not limited to, weight loss or gain, rough hair coat, kennel cough, upper respiratory infection, diarrhea, and fleas.

In Case of Medical Illness: One of the advantages of boarding your pets at a veterinary hospital is that veterinary attention is readily available should the need arise. If one of your pets becomes ill, we will call the emergency number(s) listed above regarding your pet’s symptoms, treatment options, and estimate of additional costs. If no one can be reached, however, please indicate your wishes below should your pet require treatment to relieve discomfort or to resolve an important medical condition.

After reviewing the above, please choose one:

# 1 - Please perform whatever services the doctor deems necessary for the best care of my pet until someone can be reached. This includes only non-elective treatments and any necessary diagnostics.#2 - I authorize treatment up to amount indicated below#3 - Do not administer any medical treatment until specific authorization is given.

If you selected option #2 above, please indicate the authorized amount:

$100$200Other

Please check one:

I fully intend to pick up my pet on the above date specified. I will notify the hospital of any new pick-up date.I authorize the below party to pick up my pet(s) on the above date specified. I understand prepayment of services is required. I will notify the hospital of any new pick-update.

Name of Authorized Party:

I have read and understand the boarding policies and information listed below

Date

Hospital Boarding Policies

Thank you for choosing our hospital to board your pet. We provide quality boarding with a personal touch. Every attempt will be made to give each pet individual love and attention during their visit with us. While staying with us your pet will be under the supervision of our Animal Health Technicians. Upon admission one of these professionals will provide your pet with a health examination. We strive to maintain a sanitary and healthy environment for our patients.

Vaccinations:

All pets must be up to date on their vaccinations, and it is the owner’s responsibility to make sure that proof of current vaccinations is on file with the hospital at the time of admission. If vaccinations have been administered at another veterinary hospital and they are closed at the time of admission and proof of those vaccinations is not on file, the vaccines will be brought current at the time of admission and the client will be charged accordingly. Boarding animals less than five months of age is not recommended because they may not have developed complete immunity.

Internal/External Parasites:

All pets must be free of parasites, including fleas and ticks. We require Capstar and a flea bath treatment if fleas and/or ticks are observed at the time of admission.

Rates and Payment:

Dog boarding rates are based on weight. Other services provided to your pet during boarding are charged at regular cost. Payment in full is expected when your pet is discharged. A deposit is required for first-time clients and extended boarding. Rates are calculated on a nightly basis. Boarding is charged by the number of nights stayed, and charges are updated at closing time.

Medical Illness Policy:

One of the advantages of boarding your pet(s) at a Veterinary Hospital is that medical attention is readily available for our guests. If your pet needs medical attention, we will call the emergency number that was given to us on admission. If we are unable to contact you, your pet will be treated as we deem necessary, at normal hospital fees. If your pet is currently on medication, please inform the receptionist. Charges for administering medications are based on the frequency of dosages and the means of administration. Additional fees may be applicable for senior pets that require more advanced care during their stay.

Personal Belongings:

Leaving personal belongings, i.e.: toys, blankets, bedding, etc., is allowed but discouraged due to sanitation and orderliness requirements. If you have questions about this, please discuss them with the admitting technician. The facility is not responsible for any items if lost, soiled, or damaged. Collars and leashes may not be left at any time.

Inherent Conditions:

Occasionally pets may develop problems from environmental and dietary changes. Signs may include vomiting, diarrhea, coughing, sneezing, and self-trauma such as scratching or biting their skin. We take great care so that these problems won’t occur and we treat our guests promptly if needed. However, please be aware and understand that these conditions can develop and that the hospital is not financially responsible for these inherent conditions if they do occur.

Abandonment:

Please notify us if there is any change of plans in your pet’s scheduled release date. If you do not notify us of a change in your pet’s departure date and either we do not hear from you or are unable to contact you or your authorized agent for a period of 14 days after your pet’s scheduled release date, the Hospital will consider your pet abandoned according to the animal abandonment laws in Florida. Please be advised that the pet owner will be responsible for the fees accrued and any other fees or legal services incurred by the Hospital as a result of the abandonment.

If you have any questions or problems, please call your caring Mandarin Animal Hospital staff. Thank you!

Mandarin Animal Hospital Boarding Agreement