Fairview Veterinary Hospital
Boarding Form
Owner Name
*
First Name
Last Name
Pets Name
*
Drop off/pick up information
Drop off date
*
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Pick up date
*
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
Primary Contact Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Pet Species
*
Please Select
Canine
Feline
Pets approximate weight
*
Appetite
*
Please Select
Healthy Appetite
Picky Eater
Grazer
Food Choice
*
Own-supplied food
Fairview food
Feedings Per Day
*
Amount Per Feeding
*
VACCINATIONS MUST BE CURRENT FOR BOARDING
As the owner, you are responsible for ensuring your pet has all required core vaccines at least two weeks prior to boarding. If you are not a regular client of our hospital, please email/drop off proof of vaccinations at least two weeks prior to your boarding reservation. If your pet is not up to date two weeks prior to or for the entire time period of their stay, the reservation will be canceled.
I have read and understand above statement
*
Agree
Required Vaccines
I agree that all required vaccinations; including for dogs: Rabies, DHPP (distemper) Bordetella (kennel cough); for cats: Rabies, FVRCP (distemper) will be given at least 2 weeks prior to or will be up to date for my pets entire stay.
I have read above and agree
*
My pets vaccines are up to date 2 weeks prior to boarding reservation date
Mandatory Medical Care
*
I approve medical treatment or diagnostics for my pet as deemed necessary by the veterinarian if a medical issue arises.
I would like to be contacted prior to any medical treatment or diagnostics are performed if a medical issue arises.
I understand that in an emergency situation or if I am unable to be reached my pet will be treated appropriately as the veterinarian deems necessary and will be responsible for all associated charges.
*
Agree
After Hours Mandatory Medical Care/ PLESE READ CAREFULLY
*
In the event my pet has a medical emergency when there are no doctors on premises my emergency contact can and is able to transport my pet to Urgent Care and approve medical treatment or diagnostics for my pet as deemed necessary by there veterinarian.
In the event my pet has a medical emergency when there are no doctors on premises I authorize the kennel staff at Fairview Veterinary Hospital to transport my pet to a local Urgent Care/ER for a transportation fee of $200.00. If there is no local facility able to take my pet I understand that my pet may need to be taken to Buffalo for care and accept the transportation fee of $500.00. I will be available to be contacted to discuss medical diagnostics or treatments the veterinarian may deem necessary.
I understand that when the hospital is closed there is not a Veterinarian on call. In the event my pet has an emergency situation during a time there is not a Veterinarian on premises that my pet will be transported based on my choice above to Urgent Care for assessment and treatment if needed. I agree to pay any additional fees associated to the transport or treatment of my pet at that time.
*
Agree
Flea Free Facility
I agree that the hospital is a flea-free facility and that if there are fleas present on my pet, my pet will be treated at the veterinarian's discretion and at the owner's expense.
I have read and understand the above statement
*
Agree
Will your pet be on any medications during their boarding stay?
*
No - Mark n/a below
Yes -if yes please fill out medication section below (per day charges will apply)*
Medication name(s), dosage and frequency (once a day, twice a day, every 12 hours etc.)
*
I understand I must bring medication in its original bottle, or it cannot be given to my pet.
I have read and understand
Controlled Drugs
I understand that controlled substances may not be brought into the building and if my pet is on a controlled substance they can not board at this facility.
I have read and understand the above statement
Agree
I agree that my pet is not aggressive and does not have a history of biting humans or fighting with other animals.
I have read and understand the above statement
*
Agree
Additional Information About Your Pet
My pet can have blankets during their stay.
My pet can jump over 6 feet.
My pet can be boarded with their housemate (only housemates will be boarded together.)
Service options (additional charges will apply)
I would like playtime for my pet.
I would like my pet to have a bath (including nail trim) before coming home.
I would like my pet to have a nail trim only.
Brush out.
Signature
*
Submit
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