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Menu
Home
Get Started
Pricing
FAQs
Portfolio
Contact
Forms
New Patient / New Client Form
Medical Progress Exam Form
Medical Concern Form
MEDICAL BOARDING AGREEMENT
Hospitalization Agreement
Emergency Exam Form
Annual Exam
Anesthesia/Surgical Consent Form
Tech Appointment Form
MEDICAL BOARDING AGREEMENT
MEDICAL BOARDING AGREEMENT
We provide medical boarding care to patients with medical needs and/or health issues that prevent them from being boarded at commercial kennels
Client's Name
(Required)
Pet's Name
(Required)
Date
MM slash DD slash YYYY
Client's Phone Number
(Required)
2nd Phone Number
Does your pet dig?
Yes
No
Has your pet ever bitten another animal?
Yes
No
Is your pet territorial about kennel space?
Yes
No
Is your pet friendly towards other pets?
Yes
No
Is your pet frightened by thunderstorms?
Yes
No
Has your pet ever bitten another person?
Yes
No
If yes, please give brief explanation:
Does your pet have any exercise limits? If so, please explain:
Does your pet have any sensitive areas that should not be touched?
Yes
No
If yes, please give brief explanation:
Do we have permission to give your pet Trazadone in the event of excessive anxiety?
($18 FLAT FEE)
Yes
No
Is your pet territorial about toys, food, etc.? If YES, please explain:
Does your pet have any food allergies or sensitivities?
Yes
No
If yes, please explain:
Does your pet have history of seizures?
Yes
No
If YES, please explain:
Please list all medical conditions and/or previous illness
Please list any medication that your pet will need while boarding with us. Please describe the dose you administer to your pet, how often it is given and when the next dose is needed.
Additional services: (Check any that apply)
Wellness Exam ($46)
Microchip ($48)
Heartworm test ($30)
Rabies Vaccine (Dog or Cat) ($15)
DAPP Vaccine (Dog) ($18.90)
Nail Trim ($18)
Lepto Vaccine (Dog) ($17)
Influenza Vaccine (Dog) ($42)
Anal Glands ($19)
Bordetella Vaccine (Dog) ($18)
FIV/Feline Leukemia Test? (Prior to Leukemia Vaccine) (Cat) ($38)
FVRCP Vaccine (Cat) ($20.60)
Feline Leukemia Vaccine (Cat) ($25.60)
CPR PERMISSION
(Required)
I understand Your Veterinary Practice- requires a CPR status prior to the start of any and all procedures so immediate action can take place in the event of cardiopulmonary arrest during, before, or after anesthesia or anytime in our care. I acknowledge that the attending veterinarian or staff members of Your Veterinary Practice will make every effort to contact me regarding treatment in the case of this unforeseen event. The starting cost of CPR is approximately $400. I understand that there is no guarantee of successful resuscitation.Â
Yes, please perform CPR on my pet.
No, do not perform CPR on my pet.Â
If your pet needs emergency medical attention or becomes ill, our staff will make every effort to contact you. However, if we cannot contact you, we will proceed with minimal acceptable medical care until you can be reached. You will be responsible for any incurred expenses.
(Required)
I Accept
I hereby consent and authorize Your Veterinary Practice to receive and board my pet(s). I understand the hospital will use all reasonable precautions for the safekeeping of the described pet(s), but the hospital will not be held responsible in any manner whatsoever on account of medical situations that may arise, as it is thoroughly understood that I assume all risks. I also understand that hospital personnel are not present continuously after normal business hours. I have read, understand and agree to all provisions of this agreement.
(Required)
I consent.
I fully intent to pick up my pet(s) on the date I have specified. If circumstances change I will notify TRUE COMPANION VETERINARY CARE of the new pick up date and assume responsibility for any additional charges incurred.
(Required)
I accept.
Cancellation Policy
(Required)
I understand that appointment cancellations less than 24 hours before appointment and/or no shows will incur a $30.00 cancellation fee.
Please type your initials.
Date Signed
MM slash DD slash YYYY
Signature
