Owner Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Patient Name *

Breed *

Color *

Sex *

Hartwood Animal Hospital is pleased to provide for your pet's boarding needs. Boarding charges are based on a per day basis regardless of drop-of or pick-up time. There is a minimum boarding charge of two days for overnight stays *

I have read and agree with the above statement

Date of Drop-off *

Date of Pick-up *

Time of Pick-up *

Before 12 Noon
After 12 Noon

If you would like your pet bathed, you must pick-up after 4 pm to allow your pet time to dry.

Emergency Contact Name *

Emergency Contact Number *

If my pet becomes ill or an emergency arises, I authorize Hartwood Animal Hospital to treat my pet as medically necessary for the health and comfort of my pet. *

Yes
No

If yes, I understand every attempt will be made to contact me; however, services will not be withheld if I am unreachable. I will be financially responsible for all services rendered *

I have read and agree with the above statement

Boarding Requirements

All pets staying within Hartwood Animal Hospital must be free of external and internal parasites. Any pets found to have parasites will be immediately treated with an anti-parasitic medication at additional expense to the owner *

I have read and agree with the above statement

For the safety of your pet and our staff, current vaccinations (rabies, distemper, bordetella for dogs/ rabies and distemper for cats), heartworm tests for dogs and a biannual fecal exam for dogs and cats are needed to board. If my pet is not current or current records are unavailable, I understand that these vaccines or tests will be performed today, at an additional expense to me. *

I have read and agree with the above statement

Please select the vaccination that you have done for your pet:

Examination for: (provide detail of problem)

Start treatment if needed?

Yes
No

Boarders with special needs (diabetics, epileptics, cardiac pets, and pets w/kidney issues) that require extra medical supervision will be charged as a Supervised Boarder. *

I have read and agree with the above statement

Diet Information - The cost of any prescription diets supplied by the hospital will be added to your bill.

Supplied by

Owner
Hospital

Name of Food

How Much?

How often?

Medication Info - A daily charge for medication administration will be added to the boarding charge.

Supplied by

Owner
Hospital

Name of Medication

Dose and Frequency

Last given

Need us to refill?

The cost of any medications supplied by the hospital will be added to your bill.

All leashes and collars should be removed. We provide bedding and food dishes for all pets so they are comfortable during their stay. Please note that we are not responsible for personal items that are lost or damaged while boarding. *

I have read and agree with the above statement

Please indicate below any additional services needed so we can more completely care for your pet. A charge for each additional service will be added to the basic boarding charge.

Hartwood Animal Hospital reserves the right to bathe any pet if deemed necessary due to urinary and/or fecal accidents to maintain the pet’s health, at additional cost to the owner.

I have read the above conditions, understand and agree to them. If I neglect to pick up my pet within three (3) days of the date I said I would, you shall assume that the pet is abandoned and you are hereby authorized to place the pet as you deem appropriate. I understand this does not release me from any incurred charges. *

Yes

Signature *

Clear Signature

Date *

Boarding Form

Boarding Form

Boarding Requirements

Diet Information - The cost of any prescription diets supplied by the hospital will be added to your bill.

Medication Info - A daily charge for medication administration will be added to the boarding charge.

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