AUTHORIZATION FOR BOARDING

Owner’s Name______Phone Number______Pet’s Name______

Check- in Date:______Check- in Time______Anticipated Pick-up Date______

(Boarding charges run from midnight to midnight. That time period is broken up into half days, with the cut-off time being 12:00PM noon)

I am the owner of the pet listed above and hereby consent and authorize Orchard Hills Animal Hospital to board the pet listed above and medicate if needed.

Current flea control medication is recommended. Is your pet current? Circle one: Yes or No

If my pet is found to have fleas during check-in exam, they will be treated with capstar ($10.00) and Nexgard (dogs $19.00) or Revolution(cats $19.00).__Initials

REQUIREMENTS FOR BOARDING

  1. Proof of current vaccine status MUST be provided. Dogs: Rabies, DAP, Bordetella. Cats: Rabies, HCP (or other distemper). Leukemia recommended but not required.
  2. Proof of fecal exam and or board spectrum deworming within the past 12 months.
  3. Current healthy pet exam prior to boarding.

OUTSIDE RUNS- We would like to put your dog in an outside run during the day if the weather permits. They do have the potential to get dirty. Are you ok with this? Circle one: YES or No (leash walks only)

MEDICATIONS: (An additional charge of $7.30 per day for up to 2 medications. Insulin injections using owner supplies are $14.00 per day)

MEDICATION / DOSE/FORM / DOSAGE / HOW OFTEN

FOOD (circle one): Owner’s Food OHAH Food SPECIAL DIET? YES OR NO What? ______

Feeding schedule: How much?______How often?______Last Time Given: Meds _____Food______

List any procedure, vaccines, etc. your pet need or you wish to have performed while they are boarding:

Please list any of your pet’s personal items (toys, blankets,etc.)______

(While we will do our best to keep any personal items safe and clean, please understand items can be lost or damaged during your pet’s stay.)

I am requesting my pet be sedated at the doctor’s discretion while he or she is boarding at Orchard Hills Animal Hospital. Circle one: YES NO Does your pet have a history of Seizures? YES OR NO

(If declined and your pet suffers from anxiety or stress while boarding. OHAH staff or doctors will call to discuss this with you.)

I understand that during my pet's visit, if a Doctor or Technician sees that my pet may need additional care, every attempt will be made to contact me for approval of treatment. If I am not reachable, I understand that additional charges may accrue (starting with a $45.00 exam fee).

Owner Signature ______Emergency Contact ______Date______

(It is imperative that we have a reliable phone number to reach in the event of an emergency)

BOARDING ADMIT and DISCHARGE

When <animal> was dropped off for boarding, the following items were assessed. A second exam was performed within 24 hours of <animal>’s discharge from the hospital. Any abnormalities, treatments or other recommendations are noted below.

ADMIT / DISCHARGE
Weight/Temp:
Vaccines:
Ears/Eyes/Skin:
Teeth:
Nails:
Discharge Shampoo
Staff Initials:

Did or does <animal> need any procedures performed or care provided during their stay? ______

Recommendations from Orchard Hills Animal Hospital: ______

Technician or Doctor Signature______Date______

Thank you for entrusting us with the care of <Animal>! We’ll see you again soon.