Senior Pet Medical Directive

Owner's Name*

First NameLast Name

Dog's Name*

Dog's Age*

BreedAge

We welcome all ages of dogs and dogs with physical limitations. We love seniors and we will make every effort to ensure your dog's stay is as stress free and comfortable as possible! However, boarding in a new and unfamiliar environment does naturally come with increased stress and risks. These stresses have the potential to cause latent physical conditions to become active, and potentially life-threatening. In the best interest of your pet, we request your permission to obtain immediate veterinary treatment, should it become necessary. In this event, we will attempt contact with you. If we are unable to reach you we will reach out to your emergency contact. If an emergency arises we will take your pet to Animal Clinic Northview in North Ridgeville, OH or to Wellington Animal Clinic in Wellington, OH. In the unlikely event of your dog passing away in our care, the body will be taken to the vet for storage unless you have provided Mile High K-9 with another directive.

We will make every effort to contact you in case of an emergency. In the event we are unable to contact you or your emergency contact regarding an emergency situation and must seek medical attention:*

Do everything medically possible to save my pet until I can be reachedTreatment as needed but take no heroic efforts to save my pet's life (DNR)Do Not Seek Medical Attention if you are unable to reach me

Please state the maximum dollar amount for care for your pet in your absence: *

Emergency Contact *

First NameLast Name

Phone Number*

Please enter a valid phone number.

My Emergency Contact listed above may (Choose all that apply):*

Pick up my petMake medical decisions for my petNone of the above

Please list any ongoing or current medical issues we need to be aware of, including arthritis, pain, vision or hearing loss, mobility issues, incontinence, irregular bloodwork, etc. *

The undersigned has read and understands the above, and as the owner of this pet I agree not to hold Mile High K-9 or any staff members financially or legally responsible for illness or death of my senior or terminall ill pet during or after their boarding stay. The undersigned is fully responsible for all veterinary bills incurred. I authorize these options to be used in the future until a more current Senior Pet Form has been submitted to Mile High K-9.

Date*

Date

Signature*