Boarding Authorization Form

Boarding Authorization Form

Please complete the following information. If the requested dates are NOT available, a team member will contact you for alternate dates or referrals.
Client Information*

First NameLast Name
Preferred Phone #*
Please enter a valid phone number.
OK to text this #?*

Yes!!! I like texts!No thanks. Please call me.
Patient Name*
Species*

Feline (MEEEOW!)Canine (WOOF WOOF!)
Patient Information*
Flea Preventative (Required while Boarding)*
Boarding Date(s) Requested
Preferred Drop Off Date*
Preferred Pick Up Date*
Please note: We are only open on the FIRST and THIRD Saturdays of the month for Drop Off/Pick Up (before 11:30am)
Additional Services or Treatments Requested

VaccinationsBath / Nail TrimExpress Anal GlandsOther
Southern Hills Animal Hospital REQUIRES a current Rabies Vaccination & Coughgard/Bordatella Vaccination in order to board. If your pet(s) is/are not current on these vaccinations, we would be happy to administer while here (Vaccination Exam & Vaccine Costs will apply in addition to cost to board).
FOOD / DIET

We feed Hill's Science Diet (Sensitive Skin & Stomach). If you prefer to bring your pet's normal food, it may help reduce potential upset stomach. Tell us, WHAT TYPE OF FOOD & HOW MUCH FOOD do you feed your pet daily? (Food brand/type, quantity per feeding & number of times per day - or free feed):
My Pet Eats...*
MEDICATIONS

If your pet is on medication, let us know the name, dosage, frequency & instructions (Note: please bring ALL medications in ORIGINAL container):
Medication Details:
OTHER REQUESTS OR CONCERNS?

Anything else we need to know about your baby to help them feel comfortable & at home – away from home?
The sure way to my baby's heart is...*
Occasionally, there are times when your pet will develop diarrhea and/or vomiting due to nervousness from boarding and being away from home. In some cases your pet may arrive with ear or skin conditions as well. We ask that you authorize treatment prior to leaving so that we do not bother you while you are away. Please note that if something serious does arise, we will call you.*
EMERGENCY CONTACT (Person IN Shreveport/Bossier area - just in case)*

First NameLast Name
EMERGENCY CONTACT Phone #:*
Please enter a valid phone number.

AGREEMENT

I understand that all reasonable precautions will be used to avoid any possible injury, escape, or death of this pet. It is agreed that the practice and/or staff cannot be held liable for any problem(s) that may develop, provided reasonable care and precautions are followed. I understand that ANY problem that is stated at time of drop-off, or any problem that may develop during the pet’s stay, will be treated as deemed best by the staff veterinarians. There will be a Boarding Exam Fee applied if your pet is treated by a veterinarian during his/her stay). I further understand that I ASSUME ALL RESPONSIBILITY for any associated expenses.
- It is our policy that all boarded pets must be current on above stated vaccines in order to be boarded at our hospital; I understand, and agree that if, at any time, my pet’s records indicate Rabies or Coughard vaccine(s) are due or past due, they will be brought current with that medication/treatment. IF YOUR PET IS NOT CURRENTLY ON A FLEA PREVENTATIVE, ONE WILL BE GIVEN. The fee(s) for these items will be charged at time of check-out.
- If you neglect to pick up your pet within 5 calendar days of the agreed on check-out date, and FAIL TO NOTIFY OR CONTACT US within said timeframe, it will be presumed that your pet has been abandoned. We are hereby authorized to place him/her as the hospital deems best. It is understood that doing so DOES NOT relieve you from paying ALL COSTS incurred.
- Payment will be due in full upon your pet’s arrival for their stay.
I agree to the terms and conditions described in this document:*

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Boarding Authorization Form

Boarding Date(s) Requested

FOOD / DIET

MEDICATIONS

OTHER REQUESTS OR CONCERNS?

AGREEMENT