Boarding Check-In Form

Boarding Check-In Form

Shady Brook Animal Hospital
Please enter your information so we can find your account
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com

BOARDING POLICIES

For the health of all pets boarded at Shady Brook Animal Hospital, current vaccinations, given by a veterinarian, are required:

VACCINES REQUIRED FOR DOGS: DHPP, Lepto, Bordetella, Influenza Bivalent, Rabies
VACCINES REQUIRED FOR CATS: FVRCP, Rabies

If your pet is not current on the above vaccines, vaccination will be required during their stay for their safety and the safety of the other pets in the facility.
I give my permission to the staff of Shady Brook Animal Hospital to board and to administer vaccinations, medications, and/or treatments that the veterinarian on call deems necessary for the health, safety, or wellbeing of my pet while under the supervision of Shady Brook Animal Hospital. I understand that every effort will be made to contact me if an emergency occurs. However, if I cannot be reached, medical treatment will be provided at my expense.*

I agree and understand and agree.

WHEN CAN WE EXPECT YOU?

Drop-off and Pickup Windows: M-F 8:00AM-6:00PM
Date and approximate time for drop-off*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date and approximate time for pickup*

MonthDayYear
Date
Hour MinutesAM/PM Option
I have read and understand.
I have read and understand.

EMERGENCY CONTACT

We will keep you informed regarding any updates about your pet(s), including their status and any potential evacuations or emergency situations.

Please note that we require a designated emergency contact for your pet in the event of an emergency and/or evacuation. This contact must be local and available to promptly pick up your pet if necessary.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

WHO IS COMING TO VISIT?
Pet Name*
If you are bringing multiple pets, please only list one pet's name here.

ARE WE BRINGING FRIENDS?

*At this time, please fill out a separate form for each pet. The SBAH team is working on enhancing this form to be able to include multiple pets in one form. We are sorry for the inconvenience.
YesNo
123

MEDICATIONS

Please note: there will be an additional fee of $4.00 per frequency per day.
YesNo

Please explain anything additional for {petName17}'s medication. (i.e., any preferences your pet has for medication administration.) Let us know what tricks of the trade you know.

FEEDING INSTRUCTIONS
YesNo
YesNo
How much do you feed per feeding?*
Please enter dry food amounts by actual measuring cup amounts.
How often is {petName17} fed daily?*
YesNo
Please explain:*

OVERNIGHT BAGS

You are welcome to bring any of your pet's belongings with them for their stay. We do provide bedding, water bowls, and food bowls if you choose not to.

We do not allow pets to have on any clothing or collars while they are in their room for safety precautions.

Please keep in mind, while a pet is out of their home and in an environment that is not their own, they may choose to act out a little and chew or destroy items they normally do not chew or destroy.

While we strive to provide a safe environment for every pet, Shady Brook Animal Hospital cannot assume responsibility for damage to personal belongings or for any illness or injury that may occur if a pet ingests items brought from home.
I have read the policy in regard to SBAH's left-behind pet belongings. I agree with and understand the above information. Initials*
What items will be left at SBAH with {pet17}?

CPR/DNR
As a precaution, any pet that stays in our hospital is required to have a CPR/DNR status. In the event of an unexpected cardiac or respiratory emergency, do you give consent for resuscitation efforts to be initiated until you can be contacted further and notified of their status? By consenting to this service, you are also acknowledging that certain fees will apply (that can range from $200 to $400) in addition to the charges for the services rendered from {petName17}'s boarding stay.*

I agree to CPR being performed in case of arrest.I elect a "Do Not Resuscitate" status in case of arrest.

PHOTO RELEASE

We love taking photos of your furry friends while they are staying with us. Typically, we only send them to the owner of the pet with little update on how their pet is doing during their stay. However, if we do happen to capture a photo that we think other pet lovers will enjoy just as much as you do, do you give us permission to share this photo? We will never include sensitive or personal information.
Yes, I consent for photos to be taken AND SHARED OF MY PET.Yes, I consent for photos to be taken; however, I ONLY APPROVE OF THEM BEING SENT TO MENo, please do not take any photos. I understand this means I will also not receive photos of my pet during their stay.

Boarding Consent and Release Form

REQUIRED NOTICE: LACK OF FIRE SUPPRESSION AND OVERNIGHT STAFFING

Compliance with HB 2063
Shady Brook Animal Hospital, as is allowed by Texas law, is not equipped with an on-site fire suppression sprinkler system and does not employ on-site personnel during the hours of Monday- Friday 6:00 PM- 7:30 AM, Saturday and Sunday 9:00 AM-4:00 PM and 5:00 PM-8:00 AM. All animals boarded at the Facility will be left unattended during those times.

OWNER CONSENT AND RELEASE FOR DOG OR CAT TO BE LEFT
Date*

MonthDayYear
Date
Client Name:*

First NameLast Name
Client Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Client Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Pet Name*
Breed*
Age*
Weight*
Veterinarian*
Veterinarian Phone #:*
I, the undersigned client, hereby give my consent for my pet named above to be boarded at the Facility on the following dates that are listed at the top of my boarding consent paperwork for the facility. I acknowledge that I have received and read the Facility’s notice on its lack of fire suppression and overnight staffing. I understand and acknowledge that the Facility is not equipped with an on-site fire suppression sprinkler system. I further understand and acknowledge that the Facility is unstaffed between the hours specified in the notice and that my pet will be unattended during those times during their boarding stay. By signing this consent form, I agree to release the Facility, its owners, employees and agents from any and all liabilities, claims or expenses arising from my pet’s boarding stay, including but not limited to injuries, illnesses or death. I have read and understood the statements outlined in the notice and in this consent form and release. I voluntarily consent to my pet staying at the Facility and acknowledge that I am solely responsible for any consequences that might arise during their stay.
Signature*

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Date*

MonthDayYear
Date

LAST THING!

Please let us know that you are human and not a four-legged friend or robot.
Please verify that you are human*
Should be Empty:

Rows	Name of Medication	Amount To Be Given	Frequency
Medication #1
Medication #2
Medication #3
Medication #4