AUTHORIZATION FOR BOARDING

AUTHORIZATION FOR BOARDING
Owners Information

First NameLast Name
Phone Number
Please enter a valid phone number.
Patient Information

First NameLast Name
Species Breed
I am the owner or agents for the owner of the pet listed above and have the authority to execute this consent. I hereby consent and authorize Vetfield Animal Hospital & Mobile Vet to board the pet listed above and to medicate ortreat if needed. If my pet listed above is found to have fleas during the check-in exam, they will be treated accordingly as the doctor sees fit.
REQUIREMENTS FOR BOARDING:
1. Proof of current vaccine status must be provided. Dogs: Rabies, DAPP, Influenza Bordetella. Cats: Rabies, FVRCP (or other distemper). Leukemia recommended but not required.

2. Proof of fecal exam or broad-spectrum deworming within the past 12 months.

3. Flea & Tick prevention within 30 days, and not exceeding dates of boarding. (Waives VAH of any liability for fleas and/or ticks).

4. Dogs only: Heartworm test within past 24 months and current on heartworm preventative recommended but not required.

5. No personal items such as blankets, toys, bags, pillows, etc. (blankets will be provided by VAH).
While boarding with us your pet may/may not have an underlying health issue. If so, I wish the staff of Vetfield Animal Hospital to perform CPR (Resuscitation) on my pet if my pet suffers respiratory or cardiac arrest. I understand that my pet may not respond to CPR or may respond initially and then suffer another arrest afterward.
CPR

I DO NOT want CPR performed on mypet in the event my pet stop breathing and/or his/her heart stops beating. Ielect to have a DNR (Do Not Resuscitate) order placed on my pet’s recordOR I elect that the veterinary staff stop the initial attempts at CPR that may havebeen started while I was being informed of the condition of my pet and myoptions.I wish the staff of Vetfield Animal Hospital to perform CPR (Resuscitation) on my pet if my pet suffers respiratory or cardiac arrest. I understand that my pet may not respond to CPR or may respond initially and then suffer another arrest afterward.
Pick Up Times : Mon, Tues, Thurs, Fri : 10 AM - 5pm ; Sat 10am-1pm
Check in date

MonthDayYear
Date
Check in Time

Hour Minutes

AM/PM Option
Pick Up date

MonthDayYear
Date
Pick Up Time

Hour Minutes

AM/PM Option

Medications

	Name	Dosage	How often
Medication
Medication
Medication

List your pets food here blanks if none, VAH will provide your pet with food .
Feeding Amount:blanks .
How Often : blank .
Last Heartworm Prevention given: blanks .
Last Flea/Tick prevention given : blank .
List any procedures,vaccines, etc. your pet need or you wish to have performed while they are boarding:
Signature

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Date

MonthDayYear
Date
Emergency Phone Number
Please enter a valid phone number.
While we will do our best to keep any personal items safe and clean, please understand items can be lost or damaged during your pet' stay, so we recommend not leaving blankets or toys for your pet’s stay.
Should be Empty:

AUTHORIZATION FOR BOARDING

REQUIREMENTS FOR BOARDING: