Boarding Consent Form

Please complete the form below. You will be contacted by phone if there are any questions or concerns.

Name

First Name

Last Name

Phone

(###)

###

####

Email

Pet Name(s)

If multiple, please separate with commas.

Is your pet on a special diet? If yes, please indicate what diet:

Is your pet on medication? If yes, please indicate which medication, how often the medication is given, and when the next dose will be due:

Authorized person to pick up your pet(s) if different from file name:

First Name

Last Name

South Monroe Animal Hospital boarding protocols

Please check mark each point once read and understood.

We request that you not leave any toys, collars, leashes, beds, and other personal belongings with you. We have a supply of blankets and towels that we give your pet during his/her stay. If you would like to leave items, understand that there is a possibility of your items getting lost and not returned to you. We are not responsible for lost items.

If fleas are found on your pet, they will be treated to control the fleas. By initialing, you agree to a $7.00 charge for Capstar (24 hour flea prevention) to be given orally to your pet while boarding here.

I represent that my pet(s) is in good health, is current on all required vaccinations for Canine Distemper Parvo, Rabies, 4- way Leptospirosis, and Bordetella.

I represent that my pet(s) is free of fleas, ticks, intestinal parasites, and heartworms, and is current on heartworm and flea prevention medication that prevents the spread of such parasites

I represent that my pet(s) has not been ill within the last 30 days.

I understand that if my pet experiences diarrhea during the boarding stay, clinic protocol requires that a fecal float test is performed to rule out contagious, intestinal parasites. By initialing, you agree to a $43 charge for the test and possible additional charges for dewormer if parasites are found

I understand that while my pet(s) is fully vaccinated, that vaccines are not guaranteed and there is a small risk that my pet(s) may contact a contagious disease or illness. I agree that should this occur, I am responsible for my own pet's care, medical attention, and costs.

By selecting "I agree", you are indicating that you have read an understand the boarding protocol articulated above

If your pet requires medical attention, we will try to contact you to discuss options. In the event that we are unable to reach you, and the medical issue is urgent, please indicate a budget for Doctors and staff to proceed with treatment.

Before submitting the form, please sign below with your full name, indicating that you have fully read and understood the Boarding Consent Form. You are also confirming that you have answered all questions truthfully and to the best of your ability.