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Boarding Consent Form

Client Info
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Emergency Phone*
Treat as needed?*
If my pet goes into cardiac arrest while at the Hospital:*
Patient Info
Name*
Species:*
Other:
Breed*
Sex*
Color*
Markings*
Birthdate*
Date Format: MM slash DD slash YYYY
Weight*
Check in date*
Date Format: MM slash DD slash YYYY
Check Out date*
Date Format: MM slash DD slash YYYY

**Check out day CANNOT be a Sunday (we are closed)
On Heartworm Preventative?*
Brand:*
Last date given:*
Date Format: MM slash DD slash YYYY
Does it need to be given during boarding stay?*
On Flea/Tick Preventative?*
Brand:*
Last date given:*
Date Format: MM slash DD slash YYYY
Does it need to be given during boarding stay?*
Did you bring your own heartworm or flea preventive to give during the stay with us? If so, what did you bring?*
Fleas & ticks will automatically be treated at owners expense
We recommend checking a stool sample for intestinal parasites. Do you want us to test?*
If positive, treat?*
Is your pet on other medications? If so, what?*
Items owner bringing from home*
*PLEASE NOTE THAT THESE ITEMS MAY BE LOST DURING YOUR ANIMALS STAY*
What does your pet eat and how often? Any other directions?*
Does your pet have food allergies?*
Consent*
I understand that animals boarded away from home are under stress because of the change in environment. They are predisposed to digestive upsets and respiratory infections, and some unnoticed medical problems may become apparent.
Consent*
I understand that payment is due when the animal is picked up. Pitts Veterinary Hospital accepts cash, check, debit,credit cards (Visa, MasterCard, Discover Card, Amex), Care Credit and Scratchpay .
Consent*
If I am unable to pick up my pet on the day I have indicated, I will contact Pitts Veterinary Hospital to inform them of my change in plans. If I have not contacted Pitts Veterinary Hospital within 7 days of the pick up date indicated, I hereby transfer ownership of my pet to Pitts Veterinary Hospital.
Signature:*

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Boarding Consent Form

Client Info

Patient Info

CONTACT INFORMATION

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