Boarding Consent Form

Boarding Consent Form
- Name*
  
  First NameLast Name
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Emergency Contact*
- How can you be reached?*
  
  Phone CallTextEmailUnreachable, emergency contact authorized to make treatment decisions
- Will someone else be picking up your pet?*
  
  YesNoMaybe
- Pick-up Person*
- Pet Name*
- Drop-off Date*
  
  MonthDayYear
  Date
- Pick-up Date*
  
  MonthDayYear
  Date
- Approximate pick-up time?
  afternoon, 9am, unknown, etc.
- Do you want us to give food and meds before your pet goes home?
  
  Yes, give before pick-upNo, I will give at home
- In order to maintain a flea-free environment for the comfort of all the pets staying with us and the homes of their owners, your pet will be checked for fleas and treated, if necessary, with a safe, effective, widely used, EPA approved pesticide.
- What flea-prevention do you use?*
  Nexgard, Simparica Trio, Bravecto, Revolution, etc.
- When was the last dose given?*
  
  MonthDayYear
  Date
- Are you bringing your pet's food?*
  
  YesNo, feed clinic's food
- What brand is your pet's food?*
  Purina Pro Plan Adult Essentials, IAMS urinary, etc.
- Feeding Instructions:*
- Do you have more than one pet boarding in a kennel together?
  
  YesNoIf possible
- If you have more than one pet sharing a kennel, can they be fed together or should they be separated?
  
  TogetherSeparate
- If not eating well, can your pet have baby food or sensitive stomach canned food added to meals?*
  
  YesNo
- Does your pet have any of the following?
  
  Food AllergiesSensitive StomachPrescription Diet
- What is your pet allergic to?*
  chicken, salmon, etc.
- Which prescription diet do you feed?*
  Hills i/d low fat, Royal Canin urinary so, Purina DM, etc
- When should next meal be given?*
  now, dinner tonight, tomorrow morning, etc.
- Does your pet take any medications?*
  
  YesNoOnly as needed
- Medication List*
- What is the best way for us to medicate your pet?
  in treats, place directly in mouth, crush in churu or canned food, etc.
- Please accept that Hawthorne Park Animal Care Center cannot be held responsible for the return of all items.
- Please provide color and style of the following (if applicable):
- Please list any other personal belongings, with a description of each:*
  yellow blanket with flowers, pink octopus stuffy, 3 green cloth diapers, etc. Can upload picture of belongings instead, if preferred.
- Can your pet have beds/blankets/toys in their kennel?*
  
  YesNoYes, but only items from homeOther
- Does your pet have a history of chewing or destroying beds/toys/bowls/etc.?*
  
  YesNoOther
- We thank you for boarding your pet at this facility, where we have our boarders' health and comfort in mind. Before you depart, we ask that you take a moment to review the following vaccinations required for boarding. For the health of your pet and our other boarders, we are required to administer the out-of-date vaccinations prior to your pet's stay and you will be billed our standard fees for them.
  
  We require all patients to be up-to-date on the following vaccinations:
  Dogs - Rabies, Distemper, Parvovirus, Bordetella, Canine Flu
  Cats - Rabies, FVRCP
- Does your pet have any medical conditions?*
  diabetes, seizures, heart murmur, etc.
- Do you typically use another veterinarian for services?
  
  YesNo
- Veterinary Clinic*
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Would you like to request any of the following services?
  
  Examination - $75Update Vaccinations - cost variesHeartworm Test - $76Fecal Exam (in-house) - $53Wellness Chemistry - $175Toenail Trim - $25Anal Gland Expression - $25Other - please list below
- Do you have specific concerns that need addressed?
  itchy ears, frequent urination, slowing down with age, etc.
- Any other services requested?
  All services are based on staff availability.
- In case of emergency, can staff begin treatment while trying to reach you?*
  
  YesNoYes, but with limits
- Please elaborate on allowed treatments:*
  treat anything, DNR, $500 limit, nothing until call
- Please note: While we do our very best to complete all requested services, extra services like baths and nail trims are not guaranteed during busy times or limited staffing, especially on weekends.
  
  Our team strives to complete all requested services during your pet’s stay, including baths, nail trims, and other elective add-ons. However, service completion is dependent on staff availability and scheduling demands. While we make every effort to accommodate all requests, we cannot guarantee that every service will be performed prior to discharge. If a requested service cannot be completed, our staff will notify you at the earliest opportunity. We appreciate your understanding and trust in our care.
- Upload any records, if applicable, and include any photos of your pet and their belongings that may be helpful.
  
  We strongly recommend at least uploading a picture of their belongings to help boarding staff identify and return items.
- Upload Documents & Photos (optional)
  
  can upload records from other clinics, photos of belongings, etc.
  Cancelof
- Signature*
- Date
  
  MonthDayYear
  Date
- Should be Empty: