Boarding Consent Form Page 2
ADVERTISEMENT
1
2Animal Medical Hospital At Glenwood
Boarding Consent Form
FEEDING INSTRUCTIONS
Does Your Pet Eat:
Indicate Food Brand
Hospital Diet (
)
OTHER: (
)
AM _____ PM ____
Amount You Feed
Has Your Pet Eaten Today:
AM (
)
PM (
)
WALKS AND PAYTIME
All dogs are leash walked in the morning and in the evening. An additional leash walk or off
leash play time may be added one per day. The additional leash walk is $4.50 per day and the
additional off leash play time is $15.00 per day
EXTRA WALKS AND PLAY TIME ARE DONE ONCE PER DAY WEATHER PERMITITING
MONDAY –SATURDAY
Would you like your dog to receive an additional walk? Yes ____ No ____
Initial ________
OR
Would you like your dog to receive off leash play time? Yes ____ No ____
Initial ________
(Please only choose one option additional on leash walk or additional off leash play time)
CONSENT FOR SERVICES:
To the Animal Medical Hospital of Glenwood, Inc., Stuart Scheinberg, D.V.M. and Cheryl Holmes, D.V.M. I am the owner of
the animal(s) listed above, or am responsible for it and have the authority to execute this consent. I have read and agree to
the boarding policies of AMH at Glenwood, Inc. I hereby authorize the performance of services listed above by you and your
staff. I understand that a veterinarian does not occupy the hospital 24 hours per day, but does manage and care for the
animals as needed. I agree to hold you harmless from and against any and all liability, arising out of the performance of any
procedures referred to on the occasions listed herein. I also understand that financial payments for said services are due at
the time I pick up my pet(s) unless a particular service requires a deposit in advance. The balance due will then be required
at the time of pick up.
Signature of Owner ________________________
Print Name ___________________________
Emergency Phone __________________________
Date
______________________
I will not be available to pick up my pet upon boarding discharge. Therefore, I authorize the following person to pick up my
pet upon discharge. I understand that all fees for services provided will still be required prior to discharge of my pet.
Name _______________________________ Phone Number __________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business