Boarding Form

1
Owner's Name* This field is required.
First Name
Last Name
2
Pet(s) Name* This field is required.
3
Drop off date* This field is required.
Date
Year
Month
Day
4
Is your pet aggressive?
YESNO
5
If yes, please explain:
6
Please sign below* This field is required.At Bradfordville Animal Hospital, we strive to provide your pet with excellent care and a fun experience during their stay. Although all animals are supervised during business hours, injuries can still occur especially with dogs that are easily excitable or dog aggressive. Some examples of these injuries are scratches, cuts or sprained joints. If your dog is dog aggressive and boarding in regular boarding, there is no way to ensure that your dog will not see or hear other dogs. Suite boarding is the only way to ensure complete isolation from other animals.
7
I certify that I have informed Bradfordville Animal Hospital of all animal and human aggression. I agree and am aware that I am responsible for any harm caused by my pet’s actions. This includes harm or damage to other animals and him/herself.
Clear
8
Pick up date & time* This field is required.
Date
Month
Day
Year
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
PM
AM
PM
9
Can your pet's board together?* This field is required.We are only able to board pets from the same family together.
Yes
No
10
Emergency Contact Number* This field is required.
Area Code
Phone Number
11
Other Person (s) authorized to pick up:
12
Will you be bringing food or are we feeding hospital food?* This field is required.If you bring your own food, please make sure it is labeled.
Own Food
Purina Gastrointestinal Diet (hospital diet)
13
Feeding Instructions:* This field is required.If you bring your own food, please make sure it is labeled.
14
Please describe what other service is needed:
15
Is your pet on any medications?
Yes
No
16
How many medications is your pet on?MUST BE KEPT IN SEPARATE LABELED CONTAINERS WITH PET NAME, MEDICATION NAME AND DOSING INSTRUCTIONS. Medications will be dosed according to drug label or doctor instructions.
1-2
3-4
>5
17
Please list name of the medication, dosage and how often it is to be given:MUST BE KEPT IN SEPARATE LABELED CONTAINERS WITH PET NAME, MEDICATION NAME AND DOSING INSTRUCTIONS. Medications will be dosed according to drug label or doctor instructions.
Name of medication
Dosage (how many tablets, units or ml)
Please Select
Please Select
Twice Daily
Once daily in AM
Once daily in PM
Three times daily
As Needed
Other
How often it is given
If other, please describe.
18
Please list name of the medication, dosage and how often it is to be given:Leave blank if you have no more medications to add
Name of medication
Dosage (how many tablets, units or ml)
Please Select
Please Select
Twice Daily
Once daily in AM
Once daily in PM
Three times daily
As Needed
Other
How often it is given
If other, please describe.
19
Please list name of the medication, dosage and how often it is to be given:Leave blank if you have no more medications to add
Name of medication
Dosage (how many tablets, units or ml)
Please Select
Please Select
Twice Daily
Once daily in AM
Once daily in PM
Three times daily
As Needed
Other
How often it is given
If other, please describe.
20
Please list name of the medication, dosage and how often it is to be given:Leave blank if you have no more medications to add
Name of medication
Dosage (how many tablets, units or ml)
Please Select
Please Select
Twice Daily
Once daily in AM
Once daily in PM
Three times daily
As Needed
Other
How often it is given
If other, please describe.
21
Please list name of the medication, dosage and how often it is to be given:Leave blank if you have no more medications to add
Name of medication
Dosage (how many tablets, units or ml)
Please Select
Please Select
Twice Daily
Once daily in AM
Once daily in PM
Three times daily
As Needed
Other
How often it is given
If other, please describe.
22
Please list name of the medication, dosage and how often it is to be given:Leave blank if you have no more medications to add
Name of medication
Dosage (how many tablets, units or ml)
Please Select
Please Select
Twice Daily
Once daily in AM
Once daily in PM
Three times daily
As Needed
Other
How often it is given
If other, please describe.
23
Did you already administer the medication before dropping your pet off?
Yes
No
24
Additional items left for pet:
25
Please sign below, indicating that you have read the statement below, understand and agree to its content. * This field is required.Due to the large amount of animals boarding, Bradfordville Animal Hospital is not responsible for any lost or damaged items left while boarding. Bradfordville Animal Hospital is committed to doing all that is possible to insure the health and safety of pets in our care. Because of this, all pets entering the hospital must be current on vaccinations and free from internal and external parasites (fleas & ticks). If you obtain your vaccines at another veterinary hospital and we are unable to verify the vaccines are current by close of business the day you drop off, we will vaccinate you pet per our hospital policy at the owner’s expense. Because boarding can be a stressful experience, your pet may exhibit symptoms that require medical attention. It is possible for dogs to transfer illness, such as upper respiratory infections and kennel cough, even with the required vaccinations and boosters. This is just like at a daycare for children where illness such as, pink eye and the flu can be transferred from one child to another. Such illnesses do not occur often and all dogs must have the necessary vaccinations to check-in. Should this occur, we will undertake only the amount of treatment we feel is medically necessary to help your pet. Appropriate charges will be assessed on your final bill, as you will be financially responsible. There will be an additional convenience fee per pet for anyone picking up or dropping off after hours.
Clear
Should be Empty: