You can always press Enter⏎ to continue
UVH Unleashed - Boarding Form
Hi there, please fill out and submit this form so we are ready! One form per pet please.
START
1
Have you called to schedule your pets boarding stay?
*
This field is required.
No reservation? That's okay! Please still fill out this form, but know that filling out this form does not indicate confirmation. One of our Unleashed Team Members will contact you with any questions and to give you confirmation of your reservation. Thank you and we can not wait to play with your pet!
YES
NO
Previous
Next
Submit
Press
Enter
2
Has your pet recently experienced any of the following symptoms?
*
This field is required.
- Coughing/Hacking - Sneezing/Wheezing - Vomiting - Diarrhea *Contact us immediately if your pet has experienced any of the above listed symptoms. This may effect your pet's stay with us!
YES
NO
Previous
Next
Submit
Press
Enter
3
Dog's Name
*
This field is required.
Previous
Next
Submit
Press
Enter
4
Owner Information
*
This field is required.
Please list your contact information during your pet's stay.
First Name
Last Name
###-###-#### Phone Number
Email - this is how we send photos of your pet!
Please Select
Call phone
Text phone
Email
Will not be available via phone or email, contact emergency contact
Please Select
Please Select
Call phone
Text phone
Email
Will not be available via phone or email, contact emergency contact
Preferred method to contact while you are gone?
Previous
Next
Submit
Press
Enter
5
Emergency Contact
*
This field is required.
In the event you are inaccessible during your pets stay.
First Name
Last Name
###-###-#### Emergency Contact Phone Number
Please Select
Yes
No
Please Select
Please Select
Yes
No
Is this person authorized to make medical decisions on your behalf in the event we are not able to reach you?
Previous
Next
Submit
Press
Enter
6
Prepared For Anything - Even The Unexpected!
*
This field is required.
At Unleashed, your pet enjoys an elevated, comfort-focused experience with cozy accommodations, personalized attention, and plenty of play. While emergencies are rare, our direct connection to a 24-hour veterinary hospital means we’re always ready—just in case something unexpected arises. To help us be fully prepared and honor your wishes, please take a quick moment to review the emergency consent below. It’s a simple step for peace of mind, so you can relax knowing your pet is in the best hands. I understand I will be contacted as soon as possible if an emergency arises, and that CPR efforts may involve additional medical costs. Any further treatment decisions will be discussed directly with me.
By checking this box, I am confirming I have read and understand the message above.
Previous
Next
Submit
Press
Enter
7
Emergency Medical Authorization
*
This field is required.
In the event my pet experiences cardiac or respiratory arrest while boarding, I authorize the staff of University Veterinary Hospital to take the following action (please select one):
CPR (Resuscitation) – I authorize life-saving efforts such as chest compressions, emergency medications, oxygen support, and/or intubation.
DNR (Do Not Resuscitate) – I do not authorize resuscitation. I understand that no emergency life-saving efforts will be made.
Previous
Next
Submit
Press
Enter
8
Person who may be dropping off/picking up your pet if
you
are
not
:
Owners have sole authorization to approve services and charges UNLESS permission is given by you, the owner. Please know that payment is required at the time of pick up, so please make sure this person is aware we will require payment at pick up. For convenience, you can prepay for your pet's visit. (Identification may be required)
First and Last Name
###-###-#### Phone Number
Previous
Next
Submit
Press
Enter
9
What date and time do you expect to check in your dog.
*
This field is required.
*
Unleashed Hours
:
Monday - Friday
7am - 7pm;
Saturday
7am - 4pm;
Sundays
9am-11am and 4pm-6pm.
-
Date
Month
Day
Year
1
2
3
4
5
6
7
8
9
10
11
12
9
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
30
00
00
30
Minutes
AM
PM
AM
AM
PM
Previous
Next
Submit
Press
Enter
10
What date and time do you expect to check out your dog.
*
This field is required.
Please note that check-outs after 12pm are subject to a later check out charge due to occupancy expectations. *
Unleashed Hours
:
Monday - Friday
7am - 7pm;
Saturday
7am - 4pm;
Sundays
9am-11am and 4pm-6pm.
-
Date
Month
Day
Year
1
2
3
4
5
6
7
8
9
10
11
12
9
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
00
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM
AM
PM
Previous
Next
Submit
Press
Enter
11
What type of suite is your pet staying in?
*
This field is required.
Please note if you have NOT booked yet, this is a request and we will confirm based on availability.
VIP Suites 7x7, TV, rooms with a view! $101.10 per night, per pet!
Upscale Suite 5x7; with TV! $85.49 per night, per pet!
Classic Suite 7x3. $59.28 per night, per pet!
Please also select this option if your pet is sharing a space with another dog in your family. A 10% discount will be applied to all pets who are sharing a suite together!
Medical Supervised Stay - That is another form accessible on out Client Tools page.
Previous
Next
Submit
Press
Enter
12
Have you had any concerns while boarding your dog in the past?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
13
Please Explain those concerns.
How can we make this visit a good experience.
Previous
Next
Submit
Press
Enter
14
Grooming
...we have you covered!
*
This field is required.
Just let us know your choices! -
Grooming and Deluxe Bath are subject to groomer availability **This is a request, not a confirmation of booking**
Full Service Grooming (Haircut + Deluxe Bath) - Price based on size, Starting at $83.60
Maint/Sanitary Groom (No Haircut on body, just Face, Feet, Potty Areas + Deluxe Bath) Price based on size, Starting at $64.80
Deluxe Bath (Bath, Pedicure, Anal Gland Expression, and Ear Cleaning) - Price based on size, Starting at $51.84
Standard Bath (select this option if you want a bath but are not staying for more than 3 nights) - Price based on size, Starting at $23.56
Complementary Bath (A Standard Bath is complimentary after 3 nights of boarding)
Pedicure (clip) Add On - $28.33
Pedicure (dremel) Add-on - $39.66
Ear Cleaning Add On - $25.49
Anal Gland Expression Add On - $21.41
No Grooming/Bathing Services Wanted - Including complimentary bath.
Previous
Next
Submit
Press
Enter
15
Say Cheese
! Want a picture of your pet while you're away? Just pick how often! $10.50 per picture per pet!
*
This field is required.
This is a one-way email communication and our team will not see responses.
YES - Pictures every day!
YES - Pictures every other day!
YES - Send one picture!
No, thank you
Previous
Next
Submit
Press
Enter
16
DayCare
#playwithpurpose - Full day and Half Day available Temperament Test - $43.05, Full Day - $27.19, Half Day - $16.43
Let your pup have more fun than you while with Unleashed! They can join Daycare for discounted pricing (excluding temp test)! Daycare is open 7 days a week. Your pet
must
be spayed/neutered to attend. If your pet has not attended daycare, we do require temperament testing to place your dog in the appropriate playgroup. We do
NOT
offer temperament testing on Saturday and Sunday, however, we can get that coordinated before or during your stay.
My pet needs a Temperament Test!
Full Day - once
Half Day - once
Full Day - every day
Half Day - every day
Full Day - every other day
Half Day - every other day
No Thank You
Previous
Next
Submit
Press
Enter
17
Dog Gone Fun
! Let us know what add ons you want for your pet's stay!
Please Select
Yes - once
Yes - every other day
Yes- every day
No, Thank you
Please Select
Please Select
Yes - once
Yes - every other day
Yes- every day
No, Thank you
One on One Fetch $19.25
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Please Select
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
One on One Splash Pad $19.25
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Please Select
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Extra Belly Rubs $10.50
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Please Select
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Chicken and Rice Topping (1/4 cup) $4.67
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Please Select
Please Select
Yes - once
Yes - every other day
Yes- every day
No, thank you
Pumpkin Dessert Topping $4.08
Previous
Next
Submit
Press
Enter
18
*New Item*
Enriching Lick Mat!
Give your pet a sweet treat during their stay!
1 Flavor - $5.72, 2 Flavors - $9.15, 3 Flavors - $11.44
Please Select
Once
Every other day
Every day
Please Select
Please Select
Once
Every other day
Every day
How Often?
Please Select
1 flavor
2 flavors
3 flavors
Please Select
Please Select
1 flavor
2 flavors
3 flavors
How many Flavors?
Please Select
You can pick for me
1 flavor - Peanut butter
1 flavor - Pumpkin
1 Flavor - Whipped Cream
2 Flavors - Peanut butter & Pumpkin
2 Flavors - Peanut Butter & Whipped Cream
2 Flavors - Pumpkin & Whipped Cream
Please Select
Please Select
You can pick for me
1 flavor - Peanut butter
1 flavor - Pumpkin
1 Flavor - Whipped Cream
2 Flavors - Peanut butter & Pumpkin
2 Flavors - Peanut Butter & Whipped Cream
2 Flavors - Pumpkin & Whipped Cream
Please pick your flavors
Previous
Next
Submit
Press
Enter
19
Is your pet being seen by a UVHvet during their stay? If so, what type of appointment?
*
This field is required.
Please note that if your pet is having a surgical appointment there will be additional forms to fill out for sedation consent.
Please Select
Yes
No
Please Select
Please Select
Yes
No
Yes OR No
Please Select
None
Wellness - my pet is getting their routine check-up
Diagnostic - my pet is not well or injured and needs to be assessed by a UVHvet.
Medical Progress - my pet was recently seen and needs their follow up appointment
Surgical or Sedated- my pet will be getting a procedure done or will need to be sedated for an appointment while boarding
Please Select
Please Select
None
Wellness - my pet is getting their routine check-up
Diagnostic - my pet is not well or injured and needs to be assessed by a UVHvet.
Medical Progress - my pet was recently seen and needs their follow up appointment
Surgical or Sedated- my pet will be getting a procedure done or will need to be sedated for an appointment while boarding
What type of appointment?
Previous
Next
Submit
Press
Enter
20
If your pet does not have a standing appointment but you need them to be seen, please let us know in detail what you need your pet to be seen for. (Excluding wellness)
What can we examine while your pet is with us?
Previous
Next
Submit
Press
Enter
21
Refills?
Does your pet need any medications, preventions, and/or food refilled while here? If so, do you need any of these administered during your pet's stay?
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
22
UVHonthego
- Do you need your dog picked up or dropped off?
This is subject to availability - If you select yes, we will reach out for further scheduling details. (UVHonthego is $11.17 per pet and available Monday - Friday only)
YES
NO
Previous
Next
Submit
Press
Enter
23
UVHonthego
You must live within a 10 mile radius of UVH to be eligible for Pick up and drop off
Please Select
Pick up only
Drop off only
I need both pick up and drop off
Please Select
Please Select
Pick up only
Drop off only
I need both pick up and drop off
please select which applies
Previous
Next
Submit
Press
Enter
24
Food
- Will you bring food and/or treats for your pet?
*
This field is required.
Guests that do NOT bring their own food will be fed Purina Gastro Intestinal EN - Dry for adults; or Purina Puppy Formula - Dry if less than 1 year of age.
YES
NO
Previous
Next
Submit
Press
Enter
25
You Answered "No" that you will not be bringing your own food, please tell us how you would like us to feed your pet.
How often do you feed your pet?
How much do you feed your pet? (In measurements)
Previous
Next
Submit
Press
Enter
26
You answered "Yes" that you are bringing Food and/or Treats for your pet. Please be as thorough as possible so that we can make sure we follow your instructions!
What brand of food?
How often do you feed your pet?
How much to feed (in measurements)
Treats? When to give them?
Previous
Next
Submit
Press
Enter
27
Does your pet have a food allergy?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
28
You answered YES that your pet has a food allergy - Please explain the food allergy
Our In house food is Chicken based, If your pet has a food allergy we recommend bringing your own food.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
29
Medications
- Is your pet on any medications or supplements??
YES
NO
Previous
Next
Submit
Press
Enter
30
Medication Instructions:
**You
must
bring the medication in its original container with a prescription label that matches your instructions.** Unleashed will not accept medications in daily pill boxes or Ziploc bags. We also need instructions if your pet takes medications in a certain way (pill pocket, peanut butter, etc) and you must provide those items. List name of the medication(s), how much to be given, and how often and when (AM, Midday, or PM)
Previous
Next
Submit
Press
Enter
31
Special Care Instructions
Such as leash walks only, carry up stairs, feed separate from house mate, chews blankets, any verbal commands we should know, etc. This helps us give your pet the best experience possible!
Previous
Next
Submit
Press
Enter
32
IMMUNIZATION PROTOCOL
UVHUnleashed has specific vaccination requirements for boarding/grooming/daycare animals.
"The Why" behind out protocol can be found on our website client tools page via handouts and a Vaccination Education video
https://uvhvets.com/client-tools/
We highly recommend that your pet is up to date at least 14 days BEFORE arriving for their visit to Unleashed.
Yes, we can update their immunizations during their stay. However, immunity against illnesses will be more appropriate if your pet has their boosters 2-3 weeks before their visit.
Your pet's health is our top priority!
Previous
Next
Submit
Press
Enter
33
Medical Record Request
*
This field is required.
If your pet does not use UVHvets for veterinarian services, what practice may we contact for vaccination records on your behalf.
Type UVH if you use us.
Previous
Next
Submit
Press
Enter
34
If you have your vaccination records on hand, please upload them here!
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
Previous
Next
Submit
Press
Enter
35
May we post photos of your pet on our social media or use in marketing?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
36
UVH Unleashed Agreement
*
This field is required.
We urge you to read this in full. A copy will be sent to you.
Previous
Next
Submit
Press
Enter
37
Signature
*
This field is required.
Clear
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
37
See All
Go Back
Submit
