Delray Beach Animal Hospital Boarding Check-In and Release Form
Pets Name
*
Owner's Name
*
First Name
Last Name
Emergency Contact Number
*
-
Area Code
Phone Number
I Will be picking up my pet on
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Additional surcharge for late pick up
Please select the time of pick up
Before 11am
After 11am
Other
Vaccinations
To ensure that your pet is protected as well as all other pets in the hospital,we require your pet to be up to date on all of the following vaccinations;- Rabies, Distemper, Bordetella, Parvo, FVRCP(for cats)
My pet is up to date on all of these vaccines
*
Yes
No
ALL PETS WITH FLEAS AND/OR TICKS WILL BE TREATED AT OWNERS EXPENSE WITH AN ANTI-PARSETIC TREATMENT
Food/Diet
We encourage you to bring your pet's favorite foods, please indicate if youhave brought food for your pet or if you would like us to provide the foodAdditional $5 per day for food supplied by Hospital
Please check off one of the following
I brought my own food
I would like the hospital to provide the food
Feeding Instructions: How many cups/ cans?
1 Cup
2 Cup
3 Cup
4 Cup
Please indicate what times your pet should be feed?
Special Instructions: treats/wet/dry mixture/ any tricks/habits
Medications
Is your pet on any regular prescription medication?
If your pet takes regular medication daily please indicate below the type of medication and frequency
Name of medication, how often and what time?
Name of medication, how often and what time?
Name of medication, how often and what time?
Medical Conditions
Does your pet have any medical conditions?
*
Yes
No
If so please describe;
Your Pets Behavior Habits
Is your pet aggressive towards other people?
*
Yes
No
Is your pet aggressive towards other pets?
*
Yes
No
Please note: that you are responsible for your pets behavior, if you indicate that your pet is not aggressive towards other pets or humans and your pet causes harm to other pats or people, you will be responsible for any charges related to any such harm and / or required treatments.
Medical Emergencies
If a medical emergency arises which requires emergency care and/or surgery, you hereby instruct Delray Beach Animal Hospital to proceed as follows;
You have my permission to proceed with any medical procedure without contacting me
I agree
Call me first and attempt to contact me, if no contact is made, please proceed with any care needed
I agree
Do not proceed with any care or emergency procedures until such time that I am contacted
I agree
I understand that Delray Beach Animal Hospital is not a 24 hour facility. For pets that are Boarded or Hospitalized, there will be times at night when my pet will be left unattended. I understand that I have the option of transferring my pet to a 24 hour care facility or emergency clinic at closing time. In the event of a fire, natural disaster or other emergency, it may be impossible to gain access to the building. Every effort will be made to keep pets safe and off danger. Due to the limited space of boarding availability, a 50% deposit is required for all boarding and will be refundable if canceled 3 days or prior (Holiday exceptions apply) from drop off date. Any cancellation less then 3 days in advance will not be refunded
Please list all belongings which you are dropping off with your pet; i.e Leash, bed, blanket, toys, food etc
Owner's full name :
Today's Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Owners Signature
Please verify that you are human
*
Submit
Should be Empty: