Boarding Consent Form

Boarding Consent Form

By submitting this form, you agree to have Mills Animal Hospital care for your pet with the following permission and consent:
Client/Owner Name*

First NameLast Name
Patient Name*

Patient First NamePatient Last Name
Boarding Reservation Dates*
Approx Boarding Drop Off Time

:HourMinutesAM/PM Option
Approx Boarding Pick Up Time

:HourMinutesAM/PM Option
**Please note that boarding pick up times will be after 4:00pm if a bath is selected.
Feeding Instructions
TO PREVENT GASTRO UPSET - WE REQUIRED THAT ALL PATIENTS BRING THEIR OWN SPECIAL DIET FROM HOME.

Please divide each meal into individual ziplock bags.
Food Type*
What type of food are you feeding?
Feeding Amount*
How much do you feed at one time?
Feeding Frequency*
How often are you feeding at home?
Is your pet on medications?*

YesNo
Medication List*
Please list all medications, instructions and how often they are to be given. (If none, please type "None") **NOTE: ALL medications should be in their original bottle. There is an additional charge for giving medications.
If your pet is found to have fleas, we will treat your pet with a rapidly acting flea killer and a single dose of flea preventative. There will be an additional charge for these items.*

I Acknowledge and Understand that if my pet has fleas that he/she will be given a rapid acting flea killer and a single dose of flea prevention will also be given at my expense.
Personal Property. I agree that Mills Animal Hospital shall not be responsible or liable for any lost, stolen, or damaged personal property belonging either to my dog or me. I also understand and agree that my dog’s collar will be removed upon drop off to prevent injury. This includes flea collars. An identification collar with the patient's name will be placed on each patient.*

I Understand that by leaving personal belongings with my pet, I as the owner am releasing all responsibility of Mills Animal Hospital if the belongings are lost, stolen or damaged.
Personal Belongings
In as much detail as possible, please list all belongings that you will be leaving with your pet. (ie: Blue Slow Feeder Bowl, Pink PolkaDot Leash ect.)
Emergency Contact

Please provide a good contact number where you can be reached. This number will be used in emergnecy circumstances and also to gather consent for an additional services/procedures that might need to be completed while your pet is here.
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Emergency Contact (Name)*
Please provide an emergency Contact Name for an individual that may be contacted in an emergency situation where you cannot be reached.
Emergency Contact (Phone)*

Area CodePhone Number
Email*
Unreachable Agreement: In the event that I cannot be reached, I accept an Exam and treatment of my pet in the amount of ____ (Please Select one)*

$75-$150 (Exam + Meds) I agree to the above mentioned amount if I am not able to be reached by phone.$150 - $500 (Exam + Bloodwork + Meds) I agree to the above mentioned amount if I am not able to be reached by phone.$500 - $900 (Exam + Bloodwork + Radiographs + Meds) I agree to the above mentioned amount if I am not able to be reached by phone.
Non Eating Agreement: In the event that my pet should experience anorexia (not eating for more than 3 meals) while being cared for by our hospital - I undertand that an Exam will be performed by the Veterinarian at an additional charge.*

I accept Enticing Foods and/or medication without call first (Additional Cost)I decline medications and/or food until and Exam has been completed by a Veterinarian.
CPR: In the event that my pet should experience emergencies such as cardiac or respiratory arrest while being cared for by our hospital, do you give consent for resuscitation efforts to be initiated until you can be contacted further and notified of your pets status? By consenting to this service, you are also acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the doctor’s discretion.**

I accept (Cost: $500-$1200)I decline
Medical Services

Please note that all starred services are required for boarding. By selecting these items, you are giving consent for Mills Animal Hospital to perform them. If you have any questions about the below required services, please give us a call. **If your pet is found to be due for any of the required vaccinations/tests asside from what has been selected on this consent form, a courtesy text/email/call will be given to you advising that we will be updating and the cost of services will be added to your bill at checkout.
REQUIRED Vaccines/Tests*

DHPP*Bordetella*LeptospirosisInfluenza*Heartworm Test*Felv/FIV/Heartworm Test*Rabies*Feline LeukemiaFVRCP*Fecal: Intestinal Parasite Screening***To my knowledge my pet is up to date on all of the above listed required vaccines.
Optional Treatments and Testing

Young Wellness LabworkSenior Wellness Labwork
Please list any concerns that you have for your pet that you would like for us to take care of while they are here. EXAMPLES: Fluffy has been itching for a few days, or Sam has been limping on his back leg and seems to be losing weight ect.
Canine Additional Services

Please note that all additional services hold additional charges. If you have any questions about the additional services that we offer, please give us a call. For FELINE Additional Services - please skip to the next section.
Additional Walks (approx. $13)
Limit 3 per day (NO SUNDAYS/HOLIDAYS)
Kong Peanut Butter Treat (approx. $8)
Limit 1 Daily (NO SUNDAYS/HOLIDAYS)
Homemade Frozen Treat (approx. $8)
Limit 1 Daily (NO SUNDAYS/HOLIDAYS)
Individual Play Time
Limit 1 Daily (Please indicate what days - Excluding Sundays)
The All Inclusive Spa Treatment includes a nail trim, anal gland expression, ear cleaning and general washing.

These treatments can also be selected as individual items below.

Patient will need time to enjoy their spa day and to ensure they are dry before they go home.

Pick up time for these services will be after 4:00pm
Spa Treatment Options*

All Inclusive Spa TreatmentNail TrimNail DremelAnal Gland ExpressionEar CleaningGeneral Wash OnlyNONE
Feline Additional Services

Please note that all additional services hold additional charges. If you have any questions about the additional services that we offer, please give us a call.
Solo Kitty Play Time (approx. $26)
Limit 1 Daily (Please indicate what days - Excluding Sundays/Holidays)
Catnip Sprinkle Treat (approx. $8)
Limit 1 Daily (NO SUNDAYS/HOLIDAYS)
Would you like your pet's nails trimmed?
Indicate Yes or No
General Boarding Terms and Conditions

Please read all terms before acknowledging.
Boarding and Service Agreement

This is a Pet Boarding Contract (hereinafter “this Agreement”) between Mills Animal Hospital (Marietta Veterinary Services), hereinafter called “The Hospital”) and the pet owner whose signature appears below (hereinafter called “Owner”). By signing this contract below I agree to all terms and conditions in the above statements.
Boarding Contract Acknowledgement: I have fully read, and understand and accept, the terms and conditions stated herein and acknowledge that this agreement will be effective and binding upon the parties during the entire period of participating in the said activity(s).*

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Printed Name*

First NameLast Name
Photo and Video Release. I agree to allow Mills Animal Hospital to use my pet’s name and any images or videos taken while he/she is in the care of Mills Animal Hospital, in any form or format, for use, at any time, in any media, marketing, advertising, illustration, trade or promotional materials.*

I acceptI decline
Should be Empty:

Boarding Consent Form

Feeding Instructions

Emergency Contact

Medical Services

Canine Additional Services

Feline Additional Services

General Boarding Terms and Conditions

Boarding and Service Agreement