COMPANION ANIMAL HOSPITAL BOARDING AGREEMENT

Office Use Only:

TREATMENT BOARDER

Pet:

COMPANION ANIMAL HOSPITAL - Office Hours
Monday-Friday 7am-9pm Saturday 8am-6pm Sunday 10am-4pm

Owner:

Arrival Date:

Guest(s)

Departure Date:

HEALTH INFORMATION -- ADDITIONAL PET (If you are boarding more than one pet, please submit an Additional Pet Boarding Agreement for each additional pet)

Pet's Name:

Dog

Cat

EXAM AND VACCINE INFORMATION

Our records indicate that the following required exam and/or vaccines are due:

*We require an exam be performed by one of our doctors within the last year as boarding services are for our clients only

OFFICE USE ONLY -- Client Notified on ______/______/______ LMOM TTO Initial __________

I would like my pet examined by a doctor while boarding:

Yes

No

MEDICATION INSTRUCTIONS

All medications must be in clearly labeled containers with the pet's name, medication name, and dosing instructions. We cannot give medication that has been pre-mixed in food as there is no way to ensure administration.

MEDICAL CONDITIONS:

Medication:

Directions And When Next Dose Due:

Medication:

Directions And When Next Dose Due:

FEEDING INSTRUCTIONS

We feed Pro Plan Adult Chicken and Rice or Purina EN to all boarding pets twice daily. If your pet requires a special diet or if you prefer to keep them on their regular diet, you are required to provide that diet. We are unable to feed a raw meat diet. All prescirption diets we carry may be purchased for use while your pet is here.

Please provide my pet one of these diets while they are here.

Yes

No

Owner Initials

OWN DIET PROVIDED:

Feeding Instructions: If you do not provide specific feeding instructions, we will feed twice daily based on your pet's species and weight.

Please indicate TIMES PER DAY, AMOUNT, AND SPECIAL INSTRUCTIONS.

BEHAVIOR INFORMATION

Please indicate any behavior concerns that may apply to your pet:

Please describe any behavior concerns not noted above:

ADDITIONAL SERVICES FOR YOUR PET

Nail Trim - Dog $12.50	Nail Trim - Cat $ 7.50
Anal Glands $28.00	Microchip $61.50
*Bath - Short haired dogs ONLY. See below.	**TLC - Cat $5.00 See below.
*TLC - Dog $8.00 (choose from below) See below.	With other dogs
Without other dogs

*Bath - Short haired dogs ONLY.
Please check with receptionist for pricing and availability. Your pet will be ready after 3:00 pm.

**We are able to provide TLC services a maximum of once a day on selected days.
TLC is a session of play time and special attention with your pet(s), for a duration of at least 20 minutes. The fee listed above is per session.

**TLC Amount: Please indicate once daily, every other day, and/or specific days.

BELONGINGS: Please list any belongings you have left with your pet(s):

MEDICAL CONSENT AGREEMENT & BOARDING CONTRACT

POLICIES AND GENERAL INFORMATION

We are a full service veterinary hospital that also provides boarding services for our client's pets. As such, we provide the same high standards of medical care for our boarding pets that we do for our hospital patients. Please be aware that some animals do experience stress-related illness, and may cause their chronic conditions to worsen during their stay. Please be advised that any observed untreated. or worsening pre-existing, chronic health conditions that are causing discomfort, will be treated by our veterinarians at our standard rate.

* CLIENT INITIALS:

Please pick up your pet(s) no later than 30 minutes prior to closing.
We are closed on all major holidays.

Daily TLC is required at the owner's expense for:
Puppies less than 12 months of age, AND
Any pet boarding longer than 2 weeks.

Personal belongings may be left with your pet, however, we are not responsible for loss or damage.

For safety reasons, under no circumstances will pets be released after hours.

CONSENT
I understand and agree to the Companion Animal Hospital exam and vaccination requirements for boarding, and understand if proof of vaccination cannot be provided, my pet(s) will be examined and/or vaccinated in order to meet the boarding facility standards.

For the protection of all pets under the hospital's care, external and internal parasites, including fleas, will be treated at a reasonable fee.

I acknowledge that Companion Animal Hospital will take all reasonable care for any belongings left with my pet(s), and is not responsible for loss or damage of said items.

Being away from home can be stressful and, as stated above, pets may be prone to symptoms such as diarrhea, vomiting, constipation, anorexia, etc.
If your pet experiences symptoms from stress while boarding, we will provide treatment as deemed necessary by the medical staff. Since these symptoms are typically mild and easily treatable, you will be notified upon discharge of your pet. In the event extensive treatment is necessary, we will make every attempt to reach you at the contact numbers you have provided.

I authorize Companion Animal Hospital to treat my pet(s) for any illness or injury that my arise while boarding. I give my consent to all hospital care and associated costs deemed necessary by the veterinarian and accept full financial responsibility upon pick-up.

Name of individual picking up pet(s), if other than the owner:

Emergency contact:

Phone:

Your Name:

Phone:

Owner/Agent Signature: (To be signed at time of drop off)

Date:

By submitting this form, I agree to the terms and conditions listed above,
and that the information I have provided is correct.

Please click on "SUBMIT" below.

* Indicates Response Required

Annual Exam* $55.00	DHPP; 1-3 years $15.50
Bordatella - Annual $22.50	Medication Administration $6.50/day
FVRCPC; 1-3 years $15.50	Rabies - 1-3 years $15.50
Vaccines are current	Diabetic Pet: additional fees will apply
Fecal - Annual $32.50	Lepto (dogs): Not required for boarding
FeLV (cats): Not required for boarding

Fearful or nervous	Poor appetite
Aggressive with people	Aggressive with dogs
Other - please specify below