Canine Boarding Form

Patient Name:*

Last Name:*

Boarding Date - Coming In:

Date

Boarding Date - Leaving

Date

Please let us know approximately what time you are planning on picking up so that we can make sure your pet is ready to head home! (Pick up times must be between 7a - 6p.)

Would you like for us to make sure your pet gets a bath before they leave?

Yes, I would like for them to have a bathNo, I do NOT want them to have a bath

If you are scheduled to pick up early in the morning, your pet will receive a bath the night before (except on early Monday pick-ups as those will be bathed on Saturday afternoon). If you would like a "same day bath", please schedule your pick up time after 11:00a.

Also, if you have more specific grooming needs such as a furminating bath, paw scoops, sanitary clips, complete grooming, etc. while your pet is boarding with us, please contact Muddy Buddies at 423-664-5844 as soon as possible so that you can speak with them about your requests and they can get you scheduled on their books. Thanks!

Medical Concerns:

Does your dog have any health issues (i.e. diabetes, arthritis, etc.)?*

YesNo

Please describe:

Does your dog require any special medication or treatment for the above condition(s)?*

YesNo

Please describe:

Does your dog have any allergies (food/drug):*

YesNo

Please specify:

Has your dog been seen by his/her regular veterinarian in the last 6 months for anything beyond a wellness visit?*

YesNo

Please describe:

Is your dog on any medications or supplements?*

YesNo

Please list all medication or supplements that your pet will need to receive while they are here boarding with us.... include the name, dose/mg, frequency, how it's given, that

	Medication Name	Dose/mg	How is it given?	How often is it given?	When is next dose due?	What is it for?
1st Medication
2nd Medication
3rd Medication
4th Medication

Has your dog been treated with any flea and tick medication in the last 30 days?*

YesNo

What type is he/she on?

In order to keep all of our boarders happy and healthy, IF fleas or ticks are found on your pet, the staff will be required to treat them and the medication will be added to your boarding bill. Please initial or sign that you accept this regulation. Thanks! Signature*

Behavioral Concerns:

Does your dog shred blankets, towels, bedding, etc?*

YesNo

Is your dog afraid of thunderstorms or other loud noises?*

YesNo

Any other phobias or concerns that we should know about?*

YesNo

Please explain:

Has your dog been known to climb over or dig under fencing? (We have large outside wooden runs for our boarders to get fresh air - please let us know if your pet needs to be leashed walked instead of being allowed a bit of time to get some fresh air.)*

YesNoLeash walk only

Feeding Instructions:

Will you be providing your pets own food or will you be using our Kennel Supply? (We feed Purina Pro Plan Performance 30/20)

Own FoodSequoyah's Kennel Supply

What type of food will you be bringing?

WetDryBothOther

What brand of wet food is provided and how much/often do you feed?

What brand of dry food is provided and how much/often do you feed?

It is preferred that you pre-bag each meal for your pet to make sure that we are feeding the exact same amount that they would be eating at home. By pre-bagging, this will help us keep better track of how well your pet is eating while staying with us. Often times owners will tell us to feed 2 cups of food but forget to let us know that they are referring to the "cup" that they use (which may be in their dog food bag...or not). We find that it is much easier to just remove the guesswork. Thanks so much for your help in making this process much smoother!

How many cups per meal?

How many times per day?

Once DailyTwice DailyLeave food down all dayOther feeding instructions....

Do you feed morning or evening?

AM (Morning)PM (Evening)

Other Feeding Instructions - please be as detailed as possible.

Is your pet boarding together with another pet?

YesNo

Can your pets eat together?

Yes, they can eat together...they know how to share and won't fight. (I accept all responsibility if they do get into a fight.)Yes, you can leave food with them together at all timesNo, they need to be separated to eat but can be put back together when they are done.Other

What My Pet Will Be Bringing....:

Please list items that you will be bringing with your pet......

If you are bringing your pet's bed, you understand that there is no way for us to make sure that it will be returned in the same condition that you left it. If you would like, we would be happy to use one of our beds but you are welcome to leave yours if you prefer. Please understand that some pets can get anxious when left and may tear up their bed when they have "never done that at home". Also, you understand that in the case of an "accident", we will be unable to wash your pet's bed as we do not have a front loading washer and DO have an agitator in our washing machine that keeps the beds from allowing the machine balance and spin the water out. Signature* .

Please list ALL beds, toys, blankets or treats that you will be leaving with your pet while he/she is boarding with us. (Include a brief description with colors, size, etc.)

Consent to Treat:

We would like to know how to proceed if your dog develops one of the more common medical problems that can arise while boarding. Our primary concern is ensuring your dog’s comfort and his/her ability to receive rapid medical treatment should problems occur. The common boarding ailments below describe what initial measures are taken by the staff to remedy the problem. Should your dog not respond to these initial measures, further treatment may be warranted.

Common Boarding Ailments	Initial measures taken for these ailments
Stress colitis (diarrhea)	Fecal analysis; switch to a bland diet.
Kennel nose/ kennel paw	Clean area, apply topical antiseptic
Hot spot	Clean and shave area; apply topical antiseptic
Ear Infection	Clean ears with a non-medicated cleaner

If my dog develops a medical condition while boarding, then I want Sequoyah Animal Hospital to.....

NO NEED TO CONTACT: I give my permissions to have Sequoyah Animal Hospital take initial measures to treat my pet for the above conditions or other basic medical issues (as deemed by our medical staff.... ie. torn toenail, scratch on ear, etc) should they occur. If standard protocols do not correct the problem and an exam or further treatment by the veterinarian is indicated, I DO NOT need to be contacted first. (Treat if need without consulting with owner)TREAT BASIC ISSUES - CONTACT IF MORE IS NEEDED. I give my permission to have Sequoyah Animal Hospital take initial measures to treat my pet for the above conditions or another basic medical issues (as deemed by our medical staff.... ie. torn toenail, scratch on ear, etc) should they occur. If standard protocols do not correct the problem and an exam with the veterinarian is indicated, I WOULD LIKE TO BE CONTACTED FIRST. (Try to contact owner first and if unable to reach owner, treatments are authorized as needed)DO NOT TREAT. I would like to be contacted before any measures are taken to treat my pet for any condition, including the ones listed above. I understand that if neither I nor my emergency contact is reachable, or if my emergency contact does not give permissions to treat until I am reached, Sequoyah Animal Hospital will take the necessary steps to stabilize my pet and alleviate pain and discomfort until I am contacted. Basic conditions such as diarrhea will be monitored until we hear back from the owner but conditions such as GDV which will require emergency surgery will be addressed and the owner will be responsible for any bill that occurs if we are unable to reach one of the emergency contacts. (Do not treat without consent from owner first except for emergencies).

The above conditions have been explained to me and I understand that I am responsible for all costs incurred for any exams, diagnostics and treatments provided. Please initial or sign that you accept this regulation. Thanks! Signature*

Emergency Contact Info:

Your pet's health & happiness is our primary concern. If the animal attendants notice a medical problem they will attempt to contact your emergency numbers IN THE ORDER LISTED BELOW. An emergency contact number MUST be provided upon check-in. The emergency contact person MUST be an adult, capable of making decisions for you regarding your pet's health and able to be reached within the continental U.S. Please note that whomever you choose as your emergency contact they are authorized to make medical decisions for your pet. You will assume all financial responsibilities for approved medical services provided during your pet's stay. Should a life threatening (critical) medical condition occur during their stay and attempts to reach your emergency contact are unsuccessful medical decisions regarding your pets care will be made by the doctor on duty. You will be responsible for all medical charges associated with the management of this event.

Will you be reachable by phone, text, or email during the time your pet will be boarding?

Yes, please call anytime IF NEEDEDSometimes, call me first but if you can not reach me, then call the 2nd person on my contact list.No, I will not be reachable. I will contact Sequoyah when I can to get updates and see if you are having any problems or concerns.Other

I prefer that you try to reach me by .....

Emergency Contact 1 (name/number - please list your contact info first IF you will be reachable while your pet is boarding):*

Phone Number*

Emergency Contact 2 (name/number):*

Phone Number

Emergency Contact 3 (name/number):

Phone Number

Owner Name:*

First NameLast Name

E-mail*

Your signature indicates that you have filled all of the information out accurately and that you authorize us to board your pet for the time listed accepting the charges for this service. Signature*

Date

Canine Boarding 6 Month Form

Canine Boarding Form - Complete