Medical Boarding Form

Name: Veterinarian
Brand: County Animal Hospital

County Animal Hospital is pleased to offer medical boarding as a service to our clients. To help us better care for your pet please answer the following questions

Pet’s Name

Owner’s Name

What do you feed your pet (brand, amount and frequency)?

When did your pet last eat?

Please list any medications your pet is taking:

Medication Name

Amount Given How Often

Last Given

In the last week has your pet had any of the following?coughing, sneezing, vomiting, diarrhea or scratching/biting him or herself?

Yes

If yes please describe.

Does your pet have any additional problems about which we should be aware? Please list on reverse:

Do you want your pet to receive a bath while boarding (Please ask about the extra charge for this)?

Yes

What is the best number to reach you while your pet is boarding?

Who can we contact in the event you are unreachable? (Name and Phone#)_

What day do you plan to pick up your pet?

If you are unable to pick up your pet to whom do you give us permission to release your pet? (Prepayment is required in this instance please list Name and phone#)

All pets left for boarding must be current on required vaccinations* and free of fleas and ticks.

If a doctor determines that medications are necessary for illness or anxiety, I give my permission for County Animal Hospital to administer such medications at my expense.

In the event of serious illness or emergency and if I am not reachable I authorize County Animal Hospital to make the best decision for my pet at my expense. This could include referral and transport to a veterinary specialty hospital.

Discharge will be during regular office hours. Discharges are after 10 am (please call us first). Pets who require a bath should be picked up after 12 noon (please call first to ensure your pet is dry). There are no Sunday or Holiday discharges. All fees are payable at discharge (Cash, check, Visa, Master Card, Discover Card, American Express).

I have been given and read/understand the boarding policy of County Animal Hospital.

Signature of Pet Owner or Person Responsible

Sign above

Today’s Date

*Required vaccinations: Dogs: DHPPV; Rabies, Bordetella, Influenza. Annual heartworm test and fecal required. Cats: FVRCP and Rabies. Annual fecal required. Exceptions are considered depending on medical history.

Medical Boarding Form

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