Boarding Consent Form printable pdf download

Animal Medical Hospital At Glenwood

Boarding Consent Form

Drop off Date: ______________

Pick up Date ______________

Client’s Name: __________________________________ Pet’s Name: ____________________

Regular Veterinarian: _____________________________________________________________

 Please indicate any additional services that you would like performed while your pet is

boarding?

Client Initials

 Does your pet have any medical conditions? Yes ______ No ______ If yes, please explain:

______________________________________________________________________________

 Is your pet on medication? Yes ______ No ______ If yes, please list below:

Medication 1 ____________________________ Dosing Schedule ____________________

Medication 2 _____________________________ Dosing Schedule ____________________

Medication 3 _____________________________ Dosing Schedule ____________________

A $4.00 per day medication fee will be charged for up to two different medications that are administered 1-2

times daily. For each additional medication, the fee will be an additional $2.00 per medication per day

 Have medications been given today? AM ______ PM ______

No _____

(Indicate time given)

 Is your pet currently on any flea or tick medication? Yes ____ No _____

Any animals found to have fleas or ticks upon entering the hospital will be treated, at the owner’s expense, prior

to the animal entering the boarding area.

 Would you like us to apply a single application of Flea/Tick Prevention? Yes ___ No ___

There is a $4.00 application fee, plus the medication cost which is based on the weight of your pet.

 If your pet has a tendency to chew, please let our staff know so that we may remove these

items. Remove bedding? Yes ______No ______

Boarding Consent Form